levels of experience of robotic surgery

We can't name surgeons or other medics on this forum although there are often conversations about our experiences of the various hospitals. Surgeons are supposed to publish their success rates now (a government push) and you should be able to look up these stats easily via google or similar search engines. You could also check out the surgeons you are interested in on the 'Dr Fosters' website.

A couple of words of warning though on these so called league tables - not all surgeons are publishing yet which makes comparison a little tricky. Also, the definition of success can vary quite a lot from surgeon to surgeon and hospital to hospital. For example, the stats for % of men who are able to get an erection 12 months post-surgery usually include all men who can get an erection regardless of whether they need tablets, injections or a vacuum pump to do this and also regardless of whether it is a) firm enough or b) long lasting enough for penetration. In relation to incontinence, the reporting definition of 'continent' is a man who needs one continence pad or less per day. Also be aware that some of the leading urologists have big marketing machines and snazzy websites but these do not necessarily lead to better outcomes.

The best way to find out the success rates for the surgeons you are considering is to meet them and ask:
- what % of your men have positive margins once the pathology results are back?
- what % require adjuvant treatment or salvage treatment?
- what % are completely continent and do not need any pads 6 months post op and 12 months post op?
- what % are able to have penetrative sex without chemical or physical aids 12 months and 24 months post op?
- how does the surgeon collect this data?

For what it is worth, I remain less than impressed with this idea that robotic surgery is the gold standard that everyone should seek. At present, the science cannot separate open and robotic surgery in terms of outcomes for recurrence, continence and potence so the only benefit may be in the shorter in-patient time. Based on anecdotal evidence here, there seem to be slightly more problems with strictures and incontinence than with open surgery. In addition, robotic is not always the best option in relation to previous medical history, position of the main tumour and so on. In my husband's case, we opted for open RP because the surgeon (who is one of the so-called Golden few) despite being a leader in Da Vinci felt that he had a better chance of leaving some nerves intact if he could "get his hands in" - other factors that may make open preferable to robotic or LRP include scar tissue from previous abdominal surgery (including appendectomy) or heart problems (being tipped head down for hours isn't always good for the heart).

Good luck with your research!

I had a RP in May this year at the UCHL, its a really busy place,  I was met by a surgeon pre- op, who told me that they wouldnt be able to do any nerve sparing because of the spread of the cancer, I was disappointed , I had no prior warning of this, but took it on the chin as I thought at least I can have it taken out and hopefully I will survive this ,

the following day in hospital, I was seen by another surgeon who had assisted the main consultant surgeon, he told me that they had managed to do a fair amount of nerve sparing , confused so am I , it was a bit of a convayor belt experience to begin with, so now I believe that anyone could have done it, doesnt matter what consultant you see before hand, unless your awake (which you wont be ) its a  bit of a  lottery,

sorry if I appear to be negative about this, its just my opinion, we all want the best guy to do the job, and do the best nerve sparing they can, But what's really important is that you survive and live, the rest is secondary,

youll never know for certain who performs the op, even they do not know what they will find when they start the surgery, it could be far worse than they believed or not, its an unknown factor, that wont change for the foresee able future, it doesnt come with a 100% guarantee

I have no regrets about the RP, for me it was the right decision,

                                                                    I wish you well and good luck

If you are happy with your surgeons results you can confirm with them that it will be them doing the operation.

I think Lyn is right. I had a very experienced surgeon but still left with a positive margin. I don't think this was error on his part, although who knows, but down to being a tiny focal breech and perhaps unreliable imaging results

Bri

Hi Conquistador

I had robotic assisted surgery in June this year.

My surgeon is very experienced in robotic procedures with both prostate and kidney and advises NICE on robotic  techniques. He also trains other surgeons in these procedures....

I was very happy when he assured me that he would be the one performing my operation ( I had to trust his word for that! http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-wink.gif )

I agree with others, experience of your surgeon and success rates are very important no matter what surgical procedure you choose to have...

He explained to me that with robotic assisted surgery he had much better control and vision and could perform delicate procedures very accurately.... Blood loss would be minimal, recovery should be quicker with less time in hospital ( in my case approx 24 hours )
I didn't need a drain in my wounds and had dissolvable sutures ....no nurse visit needed for clip removal.. and catheter removed after 2 weeks at my local hospital... ( check out my profile )

He also explained that in very rare cases it may be necessary to revert to open surgery if the prostate was 'stuck' to the bladder?

He told me he would spare nerves if he could, but his main objective was to get rid of the cancer.... ( I had nerves spared on one side only )

There are risks with any operation and until you have the full histology report even the surgeon doesn't know how successful he has been....

I have no regrets choosing the 'robotic route' but I'm sure other methods of surgery are equally as good, or bad, as the case may be...

Best Wishes

Luther

I know what you mean BarrieM - but it seems the thing about all this is you have to go into what ever choice you make without 100% certainty - and with limited choice)! Many thanks to all for your thoughtful replies and good wishes on this one - much appreciated.