Robotic Surgery

[FrenchRed]

Hi,

I am in the process of choosing a surgeon to work with and I fortunately have several choices in my immediate area. Some background on me, I am male, in my 50's, both age and BMI. I have the usual comorbidities, DMII, OSA, and HTN. So my choice of a surgeon is critical that I make the best choice for me for optimal outcomes.

One surgeon only does the DS open, but is well known and frequently sought out for complex cases such as revisions. The other does the DS laproscopically and is well respected. The third uses the DaVinci robotic system. I don't have insurance issues restrictions so all are equal in that regard.

Given my age and diabetes, is having the DS laproscopically important for easier healing and recovery? I haven't seen much discussed on the robot surgery - does that provide an edge for better outcomes? Any insight would be appreciated! Thanks!

[DS2000]

Who are the surgeons and where are you?

[GeekCachet]

I think it's the skill of the surgeon rather than the tools used that give the better outcome.

[Barb/Stephen]

I haven't posted in a very long time, but still read the forum several times per week. As you'll see by our signatures, I had the DS laproscopically and it was with performed with the daVinci Robotic hands. Dr. Sudan is no longer at Creighton (he's at Duke University now), but he felt there was less chance of infection with this method. I requested this method as I had had 3 Cesarean births and wanted an easier recovery. Plus, I am more pear-shaped than apple-shaped. Not all doctors who do the surgery laproscopically use the daVinci Robotic hands. I was in surgery for about 7 hrs which would be a consideration for some.

Stephen was very, very apple shaped and Dr. Sudan felt there was too much fat in the way to do the surgery laproscopically for his (Dr. Sudan's) comfort level, so his surgery was performed, "open" with a vertical, abdominal incision. Obviously, there was more wound care involved, which I was glad to provide. Stephen was in surgery about 3 1/2 hrs. His waist circumference was 62" and is now about 42".

I would say from a purely physical point of view, my recovery was easier, but then Stephen is medicinally phobic (my term) and he would have thought he was in a lot of discomfort no matter what. In my opinion, Dr. Sudan's team did a great job with pain control for both of us, and I was off the morphine pump by the second day.

So, research as best you can; I'm sure others will offer their opinions, as well.

[FrenchRed]

Thanks for the replies. I am in the Philadelphia area, so have been considering Dr. Greenbaum in NJ, and Drs. Bonanni and Antanavicius in PA. I agree that the surgeon's skill is utmost in consideration, but my question was given equal skills, are there patient characteristics like age, BMI, shape, and comorbidities, especially diabetes, which would make open versus lap more appropriate. I haven't seen much discussed about the DaVinci system, and was wondering if that gave some particular advantage to certain patients.

I seem to be quite similar to Stephen's size and age - which goes along with my sense that an open surgery approach is in my future. Certainly your comments will help me formulate the right questions to ask the surgeons.

[DS2000]

Do a comparison of the surgeons.

How many DS's has each performed? How many years has each been doing DS's? What percentage of each practice is DS's?

Have you had consults with all 3 surgeons and heard what each recommends for you specifically and why? What length common channel is each recommending for you?

(Barb - any insight into your weight gain?)

[Barb/Stephen]

Ha, ha!!
I wondered if anyone would notice that!!

In my opinion--a self-discipline issue, an emotional eater issue, too many carbs, a sedentary job, quit exercising issue, and way too many Hershey's dark chocolate nuggets with almonds, when I'm at work.

Most people would say, "well, just don't buy them." They keep my sanity, in what to me is a very stressful job. When we moved from NE to IA 18 mo ago, I was out of work for 7 mo, and had to learn a whole new job when I did get employment. I've been there 11 months now and everyone tells me that it takes 6-12 months to get a handle on it. Some days are better than others. I work for a mortgage lender and many, many people are in dire straits trying to keep their homes. In my position, I'm one of the first people with whom they come in contact.

All excuses I know. The more guilty I feel about the lack of self-discipline, then the more I want to eat to soothe my feelings. I know what needs fixing, I just don't have the emotional strength to do it.

I had a 4-5 oz stomach and obviously it has stretched. I still have some restriction because I can't eat like I could before surgery. I have to feel full to not want to eat. Does that make sense?
Barb

[DS2000]

Oh yes I understand - many people here do. In order for me not to gain weight, I must must must watch my carb intake. And my eating capacity is large now - as large as it was before surgery.

Barb how long is your common channel?

[Barb/Stephen]

At the time of our surgeries, Dr. Sudan stated he gave everyone a 100cm. common channel. Maybe when I'm older and grayer, I'll be glad for that length. How does anyone know, especially since there is so much individuality in outcomes. Barb

[DS2000]

Everybody is different, but just from the sound of your situation, you *might* not be gaining weight so much/fast if you had a 75cm channel. But who knows. I have a 75cm channel and I really think that if I had a 100cm channel, I'd be gaining weight much faster and more readily. Outcomes are so individual.