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Your detailed post was informative. I am continually amazed at the knowledge acquire. As a retired medical professional, it’s not uncommon for patients today to know as much or more about their condition than the doctor. Doctors are creatures of habit. They are taught in medical school and residency to portray a sense of superior knowledge. The dynamics of doctor/patient interaction continues to allow for narrative debate instead of blind acceptance of what the doctor tells you. We must be mindful that expertise is a trait earned. Medicine is always evolving. Your knowledge with robotic surgery seems to be spot on . But, what does that give you? There continues to be a fine line that many doctors put up to keep that aura of superiority. The latest and greatest procedure are mainly developed and performed in Centers of Excellence along with device manufacturers. In this case, most urologists are not trained in doing them. Instead of going to symposiums and possible fellowships are time consuming, so the common retort is, “I haven’t seen any evidence that this new procedure would give better outcomes from what I am doing”, (stand up, shake their hand, and walk out). COE’s have cutting edge technology. More importantly, they have teams that do an abundance of procedures. Your local city office of 10 urologists, 4 PA’s, 2 NP’s may have one doctor who might have preformed this new procedure at a hospital with the new DaVinci robotic device (Maybe a 6-week course). I would steer clear. Your knowledge of the procedure is commendable, although the foremost concern should be where to have it done. Companies like Intuative “need” COE’s that have a superior knowledge base and facilities to provide the best outcomes for new devices and procedures (Mayo, Cleveland Clinic, UCSF, UCLA, MD Anderson, Hopkins, etc.). Do additional homework on who does this procedure and how many. I had PCa and went to UVA for HDR Brachytherapy (90 minute drive, but well worth it). The local oncologist maybe performed 8/month. The Prostate Oncologist at UVA did 8/week and the facility did over 80/month. They had a specific “Prostate Oncology Center”. I can’t reinforce enough that who and where you choose will be your greatest asset for the best outcome. Good luck and keep searching.
Replies to "Your detailed post was informative. I am continually amazed at the knowledge acquire. As a retired..."
@cbball
I totally agree, the expertise of the Surgeon is key. It is unfortunate there are patients before you that were part of the learning curve that brought that Surgeon to his level of expertise. I imagine today they might have state of the art simulator’s to assist Surgeons in their learning curve. The COE’s are certainly the places to first find the new cutting age technology. Here is something I found as more recent data comes out and I was two years back. I only share this information so everyone can be aware of what is out there. The evolution of prostate surgery is continuing to evolve.
Studies consistently show that Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is superior to standard anterior robot-assisted radical prostatectomy (S-RARP) regarding faster recovery of early urinary continence and improved, sometimes faster, return to erectile function. RS-RARP preserves key anterior anatomical structures, which improves functional outcomes while achieving comparable cancer control (oncological outcomes).
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Findings on RS-RARP Superiority
Faster Continence Recovery: RS-RARP patients demonstrate significantly higher early continence rates (at 1 week, 1 month, and 3 months) compared to standard RARP, with some studies finding it reduces time to continence by over 80 days.
Improved Sexual Function: Multiple studies and meta-analyses suggest improved preservation of erectile function compared to the standard approach.
Quality of Life (QoL): Due to faster continence and potency recovery, patients report improved QoL scores.
Comparable Oncological Safety: Despite higher visibility challenges, studies indicate no significant differences in biochemical recurrence (BCR) rates between RS-RARP and standard RARP.
Lower Complications: Evidence suggests RS-RARP may lead to a lower incidence of postoperative hernia and similar or lower overall complication rates.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Limitations and Considerations
Learning Curve: RS-RARP involves a smaller, more challenging workspace, which may result in a steeper learning curve for surgeons.
Positive Surgical Margins (PSM): Some studies have suggested that RS-RARP could be associated with higher PSMs (specifically in patients with anterior lesions) compared to the standard approach, though not necessarily leading to worse functional outcomes or higher recurrence.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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These results suggest that, particularly in the hands of experienced robotic surgeons, RS-RARP can offer superior functional results for patients undergoing radical prostatectomy.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
Single-port (SP) RALP is generally considered better for patient recovery, offering less pain, shorter hospital stays, and superior cosmetic results compared to multiport (MP) RALP. Studies show SP-RALP provides similar cancer control and functional outcomes (continence/erectile function) while using a smaller 1-inch incision.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
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Key Study Findings (SP-RALP vs. MP-RALP)
Patient Recovery: SP-RALP patients often report lower postoperative pain, reduced opioid use, and faster discharge (frequently < 24 hours).
Oncologic & Functional Outcomes: Early results show similar prostate cancer control and similar or better recovery of urinary and sexual function compared to multi-port.
Technical Aspects: SP-RALP offers improved precision in limited spaces, especially through extraperitoneal approaches.
Limitations: SP-RALP has a steeper learning curve for surgeons and generally higher procedure costs.
Perioperative: Some studies suggest SP-RALP may have shorter operative times but, in some cases, higher rates of positive surgical margins, though most studies show comparable results to multiport.
UroToday
UroToday
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Conclusion
While multi-port is more common and supported by two decades of data, single-port is rapidly proving superior in terms of postoperative pain and hospital stay duration, making it a highly attractive, less-invasive option for patients.
European Urology
European Urology
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Single-Port versus Multiple-Port Robot-Assisted Radical Prostatectomy
Dec 7, 2021 — Single-port robotic radical prostatectomy was associated with shorter hospital stays. Only 60.6% of single-port patients (109/180) required analgesia compared t...
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PubMed Central (PMC) (.gov)
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@cbball
You ask if other people have tinnitus. This has been discussed at the weekly advanced prostate cancer meetings at ancan.org. Rick, Who started Ancan.Org Has mentioned having the tinnitus problem and others have mentioned it as well. Not sure the reasoning is the same as yours, but I know he has only had radiation about 14 years ago.