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I believe that, essentially, there is no difference in the ultimate outcome of normal open surgery and laparoscopic surgery – whether robotic or manual.
Surgeons who support ‘old style’ surgery say they don’t like laparoscopic because they can’t feel the material of the gland and that therefore there is a greater chance of any extensions being present. I have not seen a study that demonstrates this.
Laparoscopic surgeons say that the big advantage that this procedure has is the clear, microscopic view that is available to them and that they can therefore eyeball any suspicious areas. The clear view, it is claimed, also enables them to lessen the damage to nerves and to stitch a fine seam, so to speak, and make much better joins, especially in the urethra and this lessen bladder incontinence. Again I have not seen any definitive studies that demonstrate this clearly.
So those are the main technical arguments for and against. There is little doubt in my mind, from all the stories I have read, that recovery time is very much quicker for the laparoscopic procedure and, it seems, although I haven’t collated the data in any way, that nerve damage and incontinence issues are lower.
But having said all that, as you say so succinctly on your entry at http://www.yananow.net/Mentors/DaveM.htm Conclusion: THE SKILL OF THE SURGEON IS PARAMOUNT. That is the biggest factor without any doubt as far as I am concerned. A good traditional surgeon will outperform a novice laparoscopic one.
If I were to choose surgery as an option, I’d take LRRP, but only if I couldn’t get proton beam therapy. My personal belief is that procedure, as carried out at Loma Linda (just down the road from you) gives the very best option for long term remission with the lowest chance of morbidity. I know you’re a fireman and are used to make rapid decisions I the face of life threatening events and I know that you want this thing out of your body, but I still think you should at least investigate proton beam in your own best interest.
Out of ALL the people to respond, I was glad that YOU were the one to answer and contribute to my inquiry. You re-confirmed my beliefs. Recovery may take a bit longer, but the assurance that a SKILLED surgeon is doing the job is MOST satisfying as to why I may choose the "standard" surgery. To me, words like "remission" don't sit well with me. The demon is "still in the house" and with "him" being evicted, that is most comforting to ME. As I have read numerous times: YOU (the PC pt.) have to select the most beneficial treatment for himself. Terry, you're doing a GREAT job and this website is by far the most beneficial to any PC patient. You are to be commended with the highest honor. I will keep you and all interested parties posted. Thank you. David
I compared open RRP and Laproscopic surgery before having my own open RRP a year ago Thursday. In truth, I dismissed DaVinci (and other laproscopic) fairly quickly. I wasn't concerned about recovery time - I prioritized in my mind that first was getting rid of the cancer (Gleason 3+3, 5% in 1 of 12 samples), second in not being incontinent, third in regaining potency. My research pointed to finding the best surgeon I could, and who I felt comfortable with. Although there seem to be plenty of top surgeons out there who use DaVinci, the arguments put forth by the open surgeons just resonated with me - I really do think it comes down to comfort and surgeon skill - results will probably be comparable in the right hands with either method. I have my one year PSA in a couple of weeks, I've been pad free since around 2 months after surgery (and was using just a thin Always pad as a security blanket within 2-3 weeks of surgery), potency is bouncing back - I wish it was better but I've been told by Dr Mulhall that I'm doing very well. So, except for stressing about the PSA test, I suppose I'm fairly pleased about the whole ordeal. It's up to the surgeon to do what he needs to do in order to get rid of the cancer, but I really think the other two are in your hands almost as much as his. Continence - lots of kegels, starting now. I was diagnosed in late October and had surgery in early February (took over a month to get an appt with the sugeon I ultimately chose) and did kegels continuously in between. Potency - I was started on viagra (25mg) nightly as soon as the catheter came out - the belief is that it helps stimulate blood flow during the night. Take it religiously - after a while I got used to the stuffy nose and occassional light sensitivity and they don't seem as bad. Potency is probably 70% mental - stay positive about it - I expected my appt with Dr Mulhall to do no good, and in truth, nothing changed in my regimen, but somehow, there was a huge mental improvement that translated into a physical one.
Thanks for your input. The surgeon is the bottom line. Being comfortable with him/her is a definite plus. Yeah, I'll email you later and I'll express to you my concerns etc. I do agree with you whole heartedly: GET THE CANCER OUT PERIOD AMEN. Thanks for your input and responding.
In December I had DaVinci assisted surgery in Washington , DC. I had discussed the options: open vs. robotic, with a friend who had open prostate surgery by the dean of Washington Urologists two years previously. Since my surgery, we have been comparing results.
The outcomes were identical in terms of removing the cancer, (3+4=7, T2c, N0 MX)no cancer in seminal vesicles or lymph nodes, PSA undetectable.
The only difference we had, is that my recovery & discomfort was 1/4 his. I was walking in the evening of the surgery and home without pain medications the next noon. After a month, my incontinence was minor, only a few drips when straining.
To echo the advice of the other respondents, get a surgeon (open, lap or robotic) who has done over 400 procedures. There are many out there.
Best wishes for whatever path you choose as it will be the right one "for you".
A cancellation in Dr. Kawachi's office. I just got the call to see if I would come in tomorrow morning (2/13). My appointment was to see him next week, 2/20. He's the doc I hoped for. Over 1,000 DaVinci surgeries and at one of the top cancer hospitals in the country. Things just have a way of working out. What I've read and learned: Big hospital, skilled surgeon. Dave