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Rethinking Choice of Surgeon

LBlanks's picture
LBlanks
Posts: 44
Joined: Oct 2009

I had decided, and even have scheduled, robotic surgery at a hospital and with a surgeon about 60+ miles north of my home. He's in the same medical group as my regular Urologist, however is "out of network" for my insurance.

This surgeon operated on me 3 years ago for a tumor on my kidney and I had complications with blood clots afterward. I was admitted to my local hospital and overseen by my regular urologist who did a wonderful job seeing me through that ordeal as well as full follow-up since. I've never returned to the Doc that actually did the work until now.

That surgeon has done over 1,200 prostate surgeries using robotics, highly experienced and one of the best in the Atlanta area. However, using him would require substantial out-of-pocket costs plus follow-up would be difficult logistically. But it's not the out-of-pocket expense that's driving my decision.

My regular Urologist is excellent and is also a very good and experienced surgeon with about 50 prostate surgeries using Robotics. He's assisted on about 100 others. In fact, there are always two surgeons involved on each procedure where the other Doc uses a PA to assist him. My regular Doc is "in-network" with my insurance and I really have full faith in his abilities. Being local, the hospital is only 10 miles from my home and is a fairly new first class facility. Any problems or issues would be handled quickly since he lives close to the hospital as well.

So now my wife and I are rethinking the choice of surgeons and strongly considering my regular local Doctor, even though he's not as experienced on the robot as the other doc.

Damn, there are just too many things to consider in making these decisions!

Larry

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

Some things for you to take into account as you weigh your decision:

"RALP (robot assisted laparoscopic prostatectomy) results comparable to those obtained routinely with RRP (radical retropubic prostatectomy) were not achieved until after greater than or equal to 150 procedures. Surgeon comfort and confidence comparable to that with RRP did not occur until after 250 RALP procedures." (http://www.tripdatabase.com/doc/849489-Robotic-assisted-laparoscopic-prostatectomy--what-is-the-learning-curve-)

"The probability of creating a PSM (positive surgical margin) following RAP (robotic assisted prostatectomy) decreased with experience for a surgeon without fellowship training or prior extensive experience. Oncologic competence was achieved after 290 cases had been performed..." (http://www.dcurology.net/robotic/pdfs/positivemargins.pdf)

A Google search for something like "learning curve robotic prostatectomy" will find more articles. The numbers are all over the place, but they're significantly higher than 50.

Another Larry

janeebe3
Posts: 26
Joined: Aug 2009

You, and only you can can make the choice of Dr. Your confidence AND faith in y Dr. are just as important in your healing process. You will make the right decision for you. If you do ddecide on your Dr. He will of course have a more experianced Dr. to assist him. Good luck to you Peace of mind promotes healing! :)

LBlanks's picture
LBlanks
Posts: 44
Joined: Oct 2009

My wife and I went over all the pros and cons and decided to go with the more experienced surgeon. I'm sure my regular Doc will support this decision.
Thanks for the comments. They helped.

Larry

lewvino's picture
lewvino
Posts: 1010
Joined: May 2009

Larry,
I think you made the right choice in going with experience. You get 1 and only 1 first time shot at beating this. Go with the odds.

Another Larry

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

http://prostatecancerblog.net/?p=1861

Another Larry

hopeful and opt...
Posts: 2273
Joined: Apr 2009

When I was diagnosed, there were two doctors at UCI who did robotic surgery, one was covered by medical insurance and I think appr. 300 hundred--the other, more experienced only excepted cash, would not accept any medical coverage. It was 500 for a consult,5000 for a davinci with no complications and I think 6500 with I think cancer outside the prostate.

Well, these were the two that my doc recommended from the hospital that he practiced at--the good boy network.

So what I did; made an appt with the more experience for a little in the future, decided not to go to the less experienced, and did research in my area, and found a third choice, one who was experienced and accepted my coverage, then cancelled the doc who would only except cash.

A personal note, the more that I thought about it the more I felt that the cash doc was insensitive and out of line.

A long story, but be open to a third choice, or can you change coverage.

Bit. if there is no third choice I agree your decision is the better one......you only get one chance at this operation.

Ira

novaguy
Posts: 76
Joined: Jul 2009

Larry
I was in a similar situation. Local guy 5 miles away with a good reputation but only 100 da vinci surgeries. Another guy 30 miles away also with a good reputation and 500 da vinci surgeries. I went with the experience, and am glad I did. Not that the local guy wouldn't have done as good a job, but it's your life, and you have to go with the odds. 60 miles is nothing in comparison. You're lucky to find a surgeon with that much experience.

NM
Posts: 214
Joined: Jul 2009

Larry I feel your confusion as well. My original doctor was completely insensitive and wouldnt give out any info. on the ammount of surgeries done. I actually went back to my family doctor who recommended 2 hospitals and I went with Danville. Boy am I glad I did not only a more experienced surgeon but one who also was a urologist who only did cancer patients.

He has done more than 1000 open and over 300 Davincis. But the main reason I went with him was there was a immediate comfort level. I saw he actually cared and wanted the best for me.He listened to my questions and heard my fears.It was the toughest decision I have ever made but with a prayer and an experienced surgeon I am sure I did the right thing.

Nick

jminnj's picture
jminnj
Posts: 129
Joined: Nov 2009

Other than actually asking your doctor, is there somewhere you can find out how many robotic procedures your surgeon has actually done?

Joe

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