da Vinci learning curve for surgeon

I'm scheduled to have a total hysterectomy in early December, done by a gynecologist who's very experienced with laparoscopic hysterectomies. He's offered me the possibility (depending on scheduling issues) of having him do the surgery using the da Vinci robotic procedure. I'd asked him how many robotic surgeries he's already done, and he said he's done 3 as the lead surgeon, assisted in another 3, and observed another half a dozen or so; maybe he'll have done a few more before December. On the other hand, he's done hundreds of regular laparoscopic hysterectomies. From what I've read, it seems that the learning curve for robotic laparoscopies is at least 20 surgeries, but that may be for gynecologists/surgeons who haven't done many non-robotic laparoscopic surgeries. It seems like a lot of post-ers here think the da Vinci roboticic system is great, but given this doctor's fairly limited da Vinci experience and vast laparoscopic experience, does it seem safer to stick to having a "traditional" laparoscopic hysterectomy even if it turns out he can definitely reserve the robot for my surgery date? (There's not a lot of flexibility for me regarding the surgical date, for work-related reasons.) TIA for any replies. ravella

I personally wouldn't want to be anyone's "learning curve". Especially with a major surgery like a hysterectomy. I'd request the technique your doctor is most skilled at. hugs & healing to you!!

Wow I would run for the hills. Scary. I asked my Dr and she said thousands. I felt very reassured by that.

ravella,

Your concern is justified. Using the daVinci vs traditional methods isn't a big jump for a good doc. It's like going from a car with a manual transmission to an automatic IMHO. The skills to drive are what's important not the particular tools. At times a manual transmission has advantages and sometimes the automatic is what you want. A good surgeon will do a good job and make the best decisions for you as an individual with either method. I would probably ask the doc what he prefers and go with that.

The daVinci offers 3D imaging, more dexterity and magnification but takes longer and might need more incisions. Traditional laps offer shorter operative time and better feel (doc can feel what he's doing).

What's really important is choosing an excellent, experienced surgeon. There is so much more involved than the tools being used.

I asked my gyn about LAVH vs DvH. He said that while I *could* have the surgery DvH (the surgeon that assists him is a gyn onc who has done many of these) that it is really overkill for what I need done. He said that if I was a woman of size, or had lots of adhesions, or other tricky things to deal with, then they would lean more toward that route. But in my case (post ablation with adeno, maybe 10 lbs above my ideal weight) that DvH would be overkill. He said if I *really* wanted it, that he would ask the gyn onc what she thought, but thought that she too would think it was overkill. He reminded me that it's 5 incisions sites instead of 3, and that the only real difference is the instruments can rotate 360, which he felt really only provided a benefit if you had to go in at an odd angle or were working around obstructions.

I feel comfortable, after discussing with him, that the DvH wouldn't provide me with any real additional benefit. I would ask your gyn if the DvH would really "bring anything to the table" above and beyond the LAVH. I wouldn't want to be anyone's guinea pig, but if you're facing a tricky surgery, maybe he could bring in more skilled hands if the DvH is the better surgery for you?

Although I agree it's the skill of the surgeon, I still see a learning curve with any new technique. I personally would go with the "tried and true" for the surgeon, unless there was a true need for davinci. I'm sure not everyone would agree, but that's how I'd go. Davinci has some pros but seems to me some cons also, and I'm not convinced a new user of davinci is as good as one more experienced in that technique. Best wishes making the decision best for you.

Thanks for all the replies, and keep them coming! I am, to quote mlc03, a "woman of size" (about 50 lbs. overweight), so it's possible that's why the gynecologist thought the da Vinci might be a good option. (Part of me thinks he's like a boy with a new toy he wants to play with--and of course the hospital must have spent over $1.5 million for the robotic technology so wants to make use of it). I've had previous laparoscopic surgery for a hiatal hernia, but the dr. said that neither that nor the weight factor would prohibit having laparoscopic surgery with or without the robot. Since we're doing this because there's a small chance I might have uterine cancer (but might not)--since all the tests so far have been inconclusive--I don't know whether that fact makes robotic more or less appropriate than regular laparoscopic surgery. I won't really know what's going on with my heavily scarred uterus until they get the pathology report after the hysterectomy. One article I read said that the learning curve for the daVinci is a lot less for gyn. surgeons who've done a lot of laparoscopic surgeries previously, vs. those who haven't. But this dr. having done only a handful of da Vinci surgeries does concern me so I might request that we stick to the currently scheduled TLH (or LAVH, since the dr. said he'd take the uterus, etc., out through the vagina and I'm still uncertain which procedure this makes it). ravella