Urology

Patient Testimonials

Laparoscopic Radical Prostatectomy with Robotic Assistance (Video)

Open vs. Robotic Prostatectomy

Robotic Radical Prostatectomy Experience

Prostate Cancer and Robotic Surgery

Robotic Radical Prostatecomy Experience Under the Age of 50

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OPEN VS. ROBOTIC PROSTATECTOMY - Written by an M.D. from Maine Three treatment decisions faced me after learning I had prostate cancer: surgery vs.. radiation seeds, and, if surgery, open vs.. robotic and where? The first was a relatively easy decision for me. In view of my age (65) and otherwise excellent health, I opted for surgery to go for the surgical cure, to gain pathologic grading more accurate than the sampling on biopsy, and to establish the PSA as a monitor of the course of the disease, in addition to avoiding burning bridges for later surgery by having radiation. After reading and talking with friends, I was leaning toward robotic here in Portland at the Maine Medical Center. My surgeon here encouraged me to seek a second opinion, and I ended up seeing Dr. Jerome Richie, who has a wide reputation and deep and favorable experience with open prostatectomies. While Dr. Richie made a strong case and pushed for open, he respected my inclination to robotic and suggested I see Dr. Jim Hu, whom Dr. Richie recruited to his department to establish the robotic program. Two days later I met with Dr. Hu and learned about his training at the Center of Hope, a cancer center in Los Angeles where early work on refining robotic prostatectomies was carried out. In a year there Dr. Hu did 350 cases and assisted on 350 more while undoubtedly learning about the nuances of the procedure from those who had developed and perfected it, and during his first year at the Brigham, he had done 85 more cases. After various conversations, including anesthesiologist friends who have done cases at the MMC, I concluded that robotic is a much more precise procedure. My understanding is that the first hour is occupied with making the small abdominal wall incisions and inserting and placing the cameras and the robotic arms. The surgeon is working in a virtual surgical field with a well-lit, 3-dimensional, stereoscopic view magnified x 10. Movement of the surgeons hands and wrists is accurately transmitted to the robotic apparatus that is actually doing the cutting, suturing, etc. There is much less bleeding and tissue damage. Having decided on robotic, my most difficult decision was where to have the procedure done. I had great respect for both Dr. Hu and my Portland surgeon, and each had diligently collected data on their cases, with comparable outcomes. I ultimately opted for the Brigham and Dr. Hu, primarily on the basis of the intensity of his training. As I write this, I am 9 days post-op and doing very well. After the three and a half hour procedure in the morning, I walked a quarter mile in the hospital corridors the evening of surgery and have walked at least a mile daily since. Scheduled IV Toradol controlled post-op pain well, and I was discharged at lunch the next day. I was provided a prescription for narcotic pain medicine but never even filled it. My pain score (0 = none, 10 = worst imaginable) peaked at 3-4 the night of surgery and progressively diminished to zero by post-op day 4. "Minimally-invasive surgery" has taken on new meaning! I can hardly believe how well I have felt. I did take regular Motrin for a week as recommended. The interesting one-week experience of having a catheter is behind me, the catheter was removed successfully 2 days ago, and I patiently await return of continence. Dr. Hu was considerate to call at 6:30 on a Friday evening to share the good news that my final pathology report was favorable. Obviously, this in one person's experience but I am happy to share further thoughts with anyone facing the same decisions confronting me earlier this year.

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ROBOTIC PROSTATECTOMY EXPERIENCE - CHP, Hong Kong I am an early-stage prostate cancer patient from Hong Kong covered under a health insurance program of an insurance company in Boston.  In early February, the insurance company recommended that I travel to Boston to undertake a radical prostatectomy at BWH. For several months prior to my surgery, my wife and I had been searching for information from urologists in Hong Kong, Taiwan and the U. S. and from the internet, and had narrowed our choices to either open or robotic (da Vinci) radical prostatectomy.  After our further discussions at BWH on the pros and cons of the two choices,  we finally decided to undertake the da Vinci procedure, for these reasons: 1.  Greater surgical precision, resulting from robotic maneuvering of surgical knives and surgeon's use of more powerful magnifying lenses. 2.  Potentially lower blood loss. 3.  Shorter recovery period because of less invasive incisions. The Division of Urology at BWH assigned Dr. Jim C. Hu to carry out my da Vinci procedure.  I am very grateful to BWH for Dr. Hu's watchful medical care before, during, and after the surgery.  At the meeting on the day before surgery, I raised a number of questions related to the pending surgery, which were patiently answered by Dr. Hu.  After a negative assessment of nearby tissue, Dr. Hu proceeded to spare 90% of the left nerves, in addition to sparing 100% of the right nerves.  The post-operation pathology report indicated that my surgery was successful. I have been recovering rather quickly from the da Vinci procedure.  Shortly after surgery, I was able to move about quite well, including a walk from my hotel in Boston to the campus of MIT in Cambridge -- my alma mater. I have now returned to Hong Kong for three days, and I wish to say that the da Vinci procedure is a wonderful modern development in medical technology that has rendered tremendous help to me. The high level of team work at BWH has certainly made my surgery a success.

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PROSTATE CANCER AND ROBOTIC SURGERY I received a phone call from my urologist on December 23, 2005.  It was a day that I would never forget.  The doctor told me that I had prostate cancer.  The news was devastating; I was so numb that I couldn’t move.  He had taken eight tissue samples; one came back positive, two came precancerous, and five came back negative.  My Gleason Grade was 3 + 3 = 6.  My first thought was that I wanted to get this cancer out of my body.  My wife and I did extensive research regarding all of my options; watchful waiting (to see if the cancer grows), open surgery, robotic surgery or radiation. We visited with several surgeons and one radiologist.   After all of our research we made the decision to go with robotic surgery.  We felt that this was the best option that had the best outcome.  It was less invasive, but the most important reason for the decision was we felt the doctor utilized 3-D vision during surgery.  This allowed him to be more accurate at removing the prostate, keeping the nerves intact and stitching the urethra back together. After meeting with Dr. Hu, we decided that the best option for us was to have him perform the surgery.   He answered all of our questions and was the most experienced doctor in this field.  He also made himself readily available through electronic e-mail for any inquires and questions that we had.  My surgery was performed on March 1, 2006. I had minimal pain from the actual surgery. Nine months later, my psa is at 0.1, undetectable.  I am so grateful that I chose to have the robotic surgery with Dr. Hu.  I feel like my life is back to normal.

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ROBOTIC RADICAL PROSTATECTOMY EXPERIENCE UNDER THE AGE OF 50 As someone in my late 40’s, my experience of robotic assisted laparoscopic radical prostatectomy at Brigham & Women’s Hospital two months ago has been encouraging and helpful. The pre-op process was clearly explained and I was given things that I could do to prepare for the procedure. I practiced urinary control exercises and began a walking routine that I continue daily. The procedure went smoothly and the post-op care was outstanding. My catheter was removed after a week and I regained about 90% continence within 10 days, which I attribute not only to good surgical practice but also the pre-op exercise and continued walking. Within two weeks of the catheter removal, I was walking 5 or 6 miles a day and no longer needed diapers or pads. Within another 10 days I had received the erection assistance pump and began having dry orgasms using it with Viagra. Now, two months post-op, I’m still walking 5 – 7 miles each day, only have rare urinary leakage when bent down and sneezing unexpectedly, and am beginning to have erections just using the Viagra. While there is not much literature specific to those of us under 50 who go through this process, my example may serve to encourage others that pre and post-op exercise, following the directives of the medical staff, and keeping an optimistic attitude can create a fairly rapid recovery, despite the challenges prostate extraction brings.

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