Saturday, March 17, 2007

250 daVinci prostatectomies- What does that mean and is that enough

One of the more common questions patients ask me is how many of the robotic prostatectomies have I done. I blogged on this topic at the robotic surgery blog at my 1 year mark (Nov 2005) previously.

Ive been doing robotic surgery for well over 2 years and will perform my 250th robotic prostatectomy for prostate cancer this week.

The one factor that I can say for sure is that I can do the surgery much faster than before. The only way to make these claims is to collect data (I have a blank spreadsheet that urologists can download that has most of the information that I track) and look back afterwards and analyze my results. For my surgical times I have done this recently. I am performing more complicated prostate cancer operations that I did earlier and the times are still significantly faster.

I am in the process of collecting my data since I haven't updated it in several months. Once I do I can see what the results have been. In the operating room, I feel that I am doing a better nerve sparing operation now, especially on the harder nerves to spare. I know I have been trying to spare more nerves even with more aggressive tumors. I will need to see if this correlates to better recoveries for my patients.

As for what I mean when I state that I will do my 250th daVinci prostatectomy, I mean that I have collected every patient I have operated on and I can give an accurate number. This figure does not include removing parts of the prostate robotically for BPH (9 times), removing a prostate and bladder at the same time robotically for bladder cancer (4 times), removing a prostate laparoscopically, removing a prostate open, watching people remove prostates as a proctor, or assisting another surgeon in removing a prostate.

The reason why I state it like this is that there are many ways to count, or estimate the number of procedures that a surgeon has done. Unless we as surgeons keep accurate track of our numbers and data, our memory is often inaccurate.

I have several examples that support this: A patient of mine told me that he had seen another surgeon for an opinion and was told he had done about 100 operations. I had an email from the head of surgery that they were nearing 100 prostatectomies in total for the 5 urologists that do robotics there a few months before. Maybe he meant his whole department had done 100.

My partner told me that someone he knew was going to have his surgery at a well known hospital from a surgeon who had done 80 robotic prostatectomies. I thought that was a very good number, but had was not familiar with the surgeon. I could not find him on the davinciprostatectomy site which usually only requires 20 console side operations to be listed. The console side surgeon is listed at the discretion of the operative team however, so if 2 surgeons are sharing time on the console, either of them can be listed.

My point is that surgeons need to collect data and sometimes clarify what they mean when they answer questions, as there are multiple correct answers. I am sure I do not do this perfectly, but by keeping this in mind I can give more accurate answers.


tricia said...

I am a certified wound ostomy continence nurse and I was wondering if there is a specific foley catheter that is preferred post robotic prostatectomy.

We currently reviewed Bard and Kendall's silver impregnated silicone catheter which are firmer than latex catheters.
Tricia Foley RN,BSN,CWOCN

Domenico Savatta, M.D. said...

I do not think it matters that much what kind of catheter is used after dvP.

I avoid using larger catheters during or after surgery: Dr Ahlering at UCI wrote a paper concluding that larger catheters may lead to more strictures of the fossa navicularis. So I stay at 18 french usually.