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After 2 months of anxious waiting, my prostatectomy surgery via the Da Vinci Robot was scheduled for last Thursday at Penn Presbyterian Medical Center in Philadelphia, PA with Dr. David Lee at the controls. I entered the operating room at 12 noon and was told the surgery would take approximately 3 hours. I was awoken at 2:36 p.m. with the bad news that my surgery had to be aborted. Unfortunately, adhesions from an appendectomy performed 23 years ago prevented Dr. Lee from getting good access to the prostate. He said there was high risk of damage to the colon. I am now facing retropubic surgery. Has anyone out there had this experience?
Charlie, not exactly the same experience but some similarities.
My Da Vinci was not aborted but was only partially successfule (6 grams left behind), because of complications caused by a previous TURP operation.
My surgeon was one of the best in the world, but the previous op threw him. It may turn out to be a blessing in disguise for you that they did not continue. By carrying on not only might he have damaged your colon, or even kidneys (via ureter damage), but you could have had a pointless operation which (like me) would give you all the downsides of a prostatectomy whilst at the same time put you on a watchful waiting regime that you could have been on anyway!
I know nothing of your particular diagnosis and I am not a doctor, but maybe this is an opportunity to look more carefully at other possibilities. I am now looking at HIFU if further tests show that I still have some cancer present. If there is none I shall carry on watchful waiting/active surveillance...................which like I said, is what I could have been doing anyway!
Sorry you'll have to go though that again. My current surgeon told me that this happens every now and then. He has been called in to do an open after a problem developed during a da Vinci. I'm surprised that the doctor didn't convert to an open procedure rather than abort.
Like Ted, I also had tissue left behind after a da Vinci. It's for the better since an open will give the surgeon a better feel (literally) for the extent of the prostate.
Paul, referencing Charlie's dilemma. I think sometimes the problem with converting to open procedure maybe that the top guys on Da Vinci have done so many that it has been too long since they did open.
I asked my guy point blank if I would have been better off with open since he lost his bearings in amongst my scar tissue, and his exact words were: "It's been so long since I did one of those I'm not sure if I know how to do it anymore". (He had done 1200 of them in the past!) Now allowing for exaggeration and an attempt on his part to make me feel better, he might have a point.
The new method (Da Vinci) may be leading to de-skilling in the old methods.
I agree with you though that what has happened to Charlie may well turn out for the best for him, although I would re-iterate (not knowing enough of Charlie's story), that now would be a good time to explore all other methods.
Very good points. My current, older urologist (he's the Chief of Urology at my hospital) is often called in when a da Vinci goes wrong. He's purposely maintaining his open skills for this very reason. Too bad he didn't realize the problems with the robot when I was under the robotic knife.
Me too! But the more I think about this the more I think all the new generation of surgeons will just not know how to do an open. A bit like a modern plumber - there's just no way he could work in lead and probably could not bend a copper pipe anymore since they use plastic tubing.
This will be very worrying for those guys who are under the robot when it decides to freeze and it can't be re-booted.
I think Walsh is against the robot for the very reason that the operator has no sense of touch or feel with it. But of course he is old now and will retire soon if hasn't already. It seems obvious to me that in my case (and yours I think), that they would have had a much better view of the situation had the whole shooting match been wide open.
Having said that, when the operation suits it, the robot is less invasive and the recovery is better. But as yet, it is not so sophisticated that it can deal with anything out of the ordinary.
I would say to anyone out there who has had a TURP or ANY previous surgery in the immediate region, to quiz the surgeon ruthlessly about their skills and experience of dealing with the unusual.
Charlie, I think you may come to be grateful that your guy didn't just bang on regardless and do anything surgeons call "heroic".
Thank you for your input. I met with the surgeon who aborted my surgery last week (Dr David Lee). He explained that he ran into a situation where my colon was 'wedged' between my rectum and bladder. He tried, very carefully, for 45 minutes to slowly cut through the scar tissue, but finally decided it was too risky. I asked him why he didn't proceed with an open procedure right then. He said "My expertise is robotic. I haven't done an open since med school (15 years ago)." So he has referred me to his boss, Alan Wein, Chief of Urology at the University of Pennsylvania. He said Dr. Wein is an expert in open prostatectomy, and will be able to help me with no problem. I have an appointment on Monday (11/24) and will let you know how that goes.
Yes, I informed him about the appendectomy. Having done over 2000 robotic prostatectomies, he didn't envision any problem. He was totally surprised to see the amount of adhesions he ran into. When I met with him following the surgery, he said "Are you sure you didn't have any other abdominal surgery"? Of course, my answer was no.
On this question of adhesions and scar tissue caused by previous surgery. The uro I am seeing now to monitor the prostate tissue left behind after my Da Vinci, says that if he does a biopsy on me in the event of my PSA trending up, he will do a template biopsy, trans perineal. (Using a similar template to the ones they use in brachytherapy, I think).
I am told that the reason for this is that with such a small amount of prostate, there is a risk of "welding" it to the colon if they go through the rectum for a conventional biopsy. If it becomes fused or welded to other tissue, then, if they have to HIFU (or radiate) the remnant, they can't avoid hitting other tissue they would rather leave alone. Somebody out there correct me if I have this wrong.
I'm not a doctor, but the more I think of what happened to me (and Paul A), the more I think all guys - especially newly diagnosed - should make a thorough NUISANCE of themselves by quizzing the medics about (a) whether to operate and (b) if the medic is gung ho about operating, just how many unforseen problems did he encounter in his career and what was the outcome. How good will he and the robot be with scar tissue if there is any there.
See I'm now told that even a biopsy through the rectum IN MY CASE (not necessarily anyone else's)could cause problems for HIFU or radiation. So I think we now have to ask not only should we have the surgery but if we go for that, should it be Da Vinci?
The problem is that even if there is a good reason for doing open surgery (e.g. scar tissue from previous operations or simply the robot breaking down mid procedure), there are going to be fewer and fewer surgeons capable of doing it. Charlie's guy and mine were at the peak of their careers and yet both said that open wasn't their skill anymore.
I had my Da Vinci surgery 8 weeks ago. I was concerned about the Robot stopping and asked my Dr. about the possibility of open surgery. He told me that one of the other urologists from his practice group was going to be present during the operation. The other surgeon had 18 years experience with open surgery and if something went wrong with the Da Vinci, they would not stop, but go ahead with the open surgery. Fortunately for me, everything went well. I thought it was standard proceedure to be ready for the open in case of problems. I also know that my surgeon said that he has never had a problem with the Da Vinci proceedure in over 130 surgeries.
Thanks to all for you comments over the past several weeks. Here is an update. I had an appointment on Nov 24 with Dr. Alan Wein, Chief of Urology at Univ of Penn Hosp. He ordered a series of MRI studies to determine the extent of adhesions. I had a follow up appointment with him today. He informed me that the MRI report indicated that I had a large presence of fatty tissue (lipomatosis) in the region of my bladder and prostate. He said he could still perform the open surgery, but that the fatty tissue would likely cause more bleeding than normal. Nonetheless, he recommended that I see a radiation oncologist before I decide on the surgery. That appointment is tomorrow. Stay tuned.
It is not unusual for Robotic surgery to convert to open. I had an excellent surgeon (performed the most LARPs in Nebraska)who ran into complications. I had a double fracture of the pelvis in '94. He said trying to get to the prostate and lymph nodes was similar to pouring molasses on a newspaper, then trying to separate the pages. I was in surgery for almost 4 hours and in the hospital for 5 days. The tumor had attached itself to the rectum wall. I'm sorry you have to go back in to surgery. This is major surgery and you can't just bounce back from it.