Private Robotic Surgery

Hi Pat, I am not sure what you are asking? Whether you could pay privately for robotic surgery to the prostate? I imagine an awful lot of hospitals in Scotland and the north of England would offer it privately but you shouldn't actually need to go private - just ask your doctor to refer you to an alternative hospital on the NHS.

However, I wonder why you are so intent on robotic? The data suggests that the outcomes (in terms of getting all the cancer out, likelihood of it returning later, and risk of long term side effects) are identical for open surgery, keyhole and robotic so with a bit of background reading you would possibly come to the conclusion that what is much more important to you is the experience of the surgeon. Your chances are much better having keyhole or open RP with a very experienced surgeon at Edinburgh than they would be with a surgeon in Newcastle (or wherever) who has only done a handful of robotic ops.

You could go back to your nurse specialist or even the surgeon to ask some questions like how many ops has he done in the last 12 months, what % of the men had negative margins, what % have needed additional treatment after the op and what % have been left with permanent incontinence or impotence. Then make a decision about whether you want to visit a surgeon who offers Da Vinci (robotic)

No point making assumptions about the guy who went to Germany unless you know all his personal data as there may have been a specific reason that he needed treatment overseas. There are some men who cannot have surgery in the UK because surgeons have to report their success rates publicly which makes some hospitals reluctant to operate on men who might already have some spread, for example. Also, men that have had radiotherapy in the past can find problems getting a surgeon to agree to salvage surgery whereas in Germany, it is perhaps easier to arrange.

Yes, I wouldn't think that a retired surgeon in the UK would have his op in Germany to possibly save a few pounds. Top surgeons in Europe tend to know other personally or by reputation and how they go about procedures so this may have been the reason and possibly also an earlier slot for the op. A situation applies in pancreatic cancer where a certain surgeon in Germany has in a number of cases been able to successfully operate on cases that were considered non operable in the UK.

Edited by member 18 Nov 2015 at 16:35  | Reason: Not specified

"As Lyn suggests, outcomes for recurrence might not be much different but for least impact re: incontinence and ED, the DA Vinci treatment seems to be much better. Now I don't have the stats to hand, but personally, I'm 1 year in, was fully continent at 6 weeks. ED problems took longer but steadily improved ....."

I think that is the opposite of the findings William - the data from the Europe-wide research indicated that likelihood and longevity of incontinence and ED is slightly better for open RP. So men need to weigh up 'do I want less time in hospital and quicker physical recovery' v 'do I want a better chance of regaining continence and sexual function'? The likelihood of needing salvage or adjuvant treatment appears to be almost identical either way.

Edited by member 18 Nov 2015 at 21:33  | Reason: Not specified

I certainly don't think keyhole or robotic are the cheaper option - the technology is expensive to develop, the machines cost a fortune, training the surgeons also costs a bomb. But once the machine has been purchased and the doctor has been trained, there are cost benefits in that most men are in-patients for only a day or two as opposed to open where the bed will be blocked for 5 or 6 days.

It seems to me that this is part of why it is pushed in some hospitals - once they have persuaded the commissioners to lay out, they need to use it to prove it was a good spend. And for men suitable for keyhole, the benefit in speedier physical recovery and sooner return to work is also appealing. Less blood loss makes keyhole safer for men with blood related disease. On the flip side, the operation is much longer so more general anaesthetic is needed and the fact that you are tipped head down makes it a dangerous option for men with heart problems, for example.

The main reason that John opted for open was that scar tissue from previous abdominal surgery was going to make it difficult for the surgeon to do a 'clean' da Vinci and, crucially, John had a suspect node. This was significant simply because our hospital does not remove lymph nodes during keyhole, only in open surgery (this seems to be an unusual policy) Faced with the choice - keyhole, but leave the lymph node and wonder what if OR open with longer off work but more chance of getting everything out and leaving some nerve bundles intact - it seemed a no-brainer. In the end, each man must make a decision about what is best for him and knowing what was best for someone else won't really help.