Robotic surgery summary- September 2007

In September I performed 19 operations including 13 dvPs.
One simple prostatectomy was combined with a left inguinal hernia repair. This was the first time I had performed this combination, although I have performed close to 50 hernia repairs at the time of dvP.
The new thing to report is an improvement in continence that I have seen after adding a few sets of sutures to re-construct the pelvic anatomy after removal of the prostate and before the connection is made. I had been doing part of this since I read a paper from Rocco describing his procedure of repairing anatomy behind the connection of the bladder to the urethra. This addition has helped more men achieve quicker urinary control in my experience.
Dr. Tewari has added an additional technique to reconnect the anatomy in front of the connection site.
I have added some of my own modification and have seen a nice short term improvement in urinary control. The best part is that the cancer control has not been compromised in these patients and my positive margin rate has declined.

Experience matters for prostate cancer surgery

Study tracks ‘learning curve’ in prostate surgery –

In this study, experience was measured not by age or years as a surgeon but by the number of times doctors performed this operation.
“Advice for patients is to try to seek out experienced surgeons, and they’re likely to be ones who specialize in the procedure,” Andrew Vickers of Memorial Sloan-Kettering Cancer Center in New York City, one of the researchers, said in a telephone interview.
The researchers followed 7,765 prostate cancer patients who underwent an operation called radical prostatectomy performed by 72 surgeons at four U.S. academic medical centers in New York, Texas, Michigan and Ohio from 1987 to 2003.
As the number of times a doctor performed it increased, the number of patients who remained cancer-free five years after the surgery also rose, the researchers wrote in the Journal of the National Cancer Institute.
But at a certain point the improvement in surgical outcome topped out and stabilized regardless of how many more times a surgeon did the procedure.
“The learning curve for prostate cancer recurrence after radical prostatectomy was steep and did not start to plateau until a surgeon had completed approximately 250 prior operations,” the researchers wrote.

Surgeons should not be judged on their age or years of experience (35 years old and 8 years of experience for me), but by the number of prostates they have removed. This is one of many studies that shows better cure rates from more experienced surgeons.
This study looked at open surgeries, but I think robotics will also be similar. My personal numbers are over 500 prostatectomies of all types and over 350 robotic prostatectomies.