TRANSCRIPT OF CHAT WITH HARTFORD HOSPITAL DOCTORS
wfsb Welcome to our live chat. Feel free to begin submitting questions for the doctors.
sandra Having robotic surgery 4/1 a tHartford. Program was very informative.
galatea If one has an enlarged uterus is abdominal surgery usually recommended over robotic surgery?
Joseph_Wagner_MD GOod question. THis is Dr. LaSala. Depending on the size of the uterus, and the reason why it needs to be removed, YES, there is a chance it can be done robotically. This is a nice option as it saves you from having a bigger incision on your belly. THe surgery may take a bit longer via robot, because the uterus has to be removed in smaller pieces through the small ports. KEY: go to a gyn who has experience in this and to a hospital that does many of these. Dr's Odie Kuiper, Fred Rau and Peter Doelger are all great here at Hartford HOspital
Tammy Dr. Shichman...I am thankfull that you were there for my boyfriend (Matt McClusky)...you saved his life...for that I am able to spend MANY happy years with him...Tammy
Sarah_B What is Dr Wagner's Specialty?
Joseph_Wagner_MD(A) urology, specifically minimally invasive and robotic surgery.
Germaine_Landry(C) I'm greatful to you Dr. Wagner for saving my life Sept. 2005 for kidney cancer.
rob(Q) my friend has an alchohol addiction and suffers bouts of anxiety. She also says that she was diagnosed with a heart arythmia (sp)? My question is.. Is the fact that she has arythmia associated with her anxiety, thus part of the reason she drinks_ as she says to calm herself. I am wondering if the heart robotics surgery you featured on tonights program would help?
Joseph_Wagner_MD(A) The atrial fibrillation could be secondary to the alcohol use. The anxiety could be worsened by the atrial fibrillation. Your friend should seek help to stop drinking first prior to considering any other treatment for the atrial fibrillation.
richard_roberts(C) Dr Wagner. You did robotic surgery on my husbannd Richard 3 years ago for prostate cancer. I can not thank you enough, for preforming a sucsessful prostatecomy. Being only 50 when he had the surgery, being able to spare his nerves is a very important thing ofr us. 3 years later he is still cancer free Thank you
liz(Q) Is atria fibrillation ablation a common procedure
Joseph_Wagner_MD(A) Yes it is. We perform over 50 of them yearly and are doing more every year. - Dr Zweibel
Jean_Merz(Q) Dr Wagner, does anyone at Hartford Hosp do robotic surgery for esophageal cancer?
Joseph_Wagner_MD(A) No - only laprascopic surgery - but not using the robot.
Marcy_D(Q) How long are your patients in the hospital for, what are their restrictions if any ie: lifting restrictions, sexual activity restrictions.
Joseph_Wagner_MD(A) Just in the hospital overnight. No restrictions on lifting or sexual activity.
Marcy_D(Q) How many cases did you perform before you felt comfortable leaving the patients side in the O.R. and sitting at the daVinci console.
Joseph_Wagner_MD(A) Immediately. This must be done for every procedure with the robot.
Joseph_Wagner_MD(C) Richard - Glad to hear you are doing well. Thanks for the kind words.
sandra(Q) Is it more complicated to have a hysterectomy and cystocele repair at the same time with the robot?
Joseph_Wagner_MD(A) not at all as they are commonly done together. Dr. LaSala
Jean_Merz(Q) Doctor Wagner: who would you refer us to for laprascopic surgery for esophageal cancer?
Joseph_Wagner_MD(A) there is a surgeon at HH who is a specialist in this: David CUrtis. You can call the HH referral line to get his number. (860) 545-1888
Jeff(Q) Is robotic surgery used to treat head and neck cancer?
Joseph_Wagner_MD(A) no, not here (in Japan they do)
hhellstrom(Q) Dr Wagner, how long does the incontience last, after a prostatectomy?
Joseph_Wagner_MD(A) dr kesler here. The true answer is that it can vary
Marcy_D(C) I'm an O.R. nurse who's hospital is just starting up a Robitic program. We were given the oportunity to train with the Robotic team at Hartford Hospital and our team cannot express our gratitude to your program for the expertise and knowledge your staff shared with us. Thank you doesn't seem like enough, please thank your team once again for us.
suemack4(Q) How long of a recervery time after a prolaspe bladder surgery is ther and is is alway done by roboic?
Joseph_Wagner_MD(A) Good Q. THis is Dr. LaSala. Depending on the size of the prolapse and whether or not there is incontinence, this surgery may be done vaginally, which is even less invasive than robotic surgery.
RobinB(Q) Is one able to had most all proceedures to correct pelvic floor prolaspe with robatic surgery and if so what is the standard recovery time?
Joseph_Wagner_MD(A) THiis s Dr. LaSala: the main role for robtic surgery for prolapse is to address dropped bladders (that are significantly dropped: i.e. you can see it or feel it beyond the opening of the vaginal) as well as for when the TOP of the vagina has dropped, or the UTERUS has dropped. Otherwise, some of this surgery can be managed transvaginally, which is even less invasive. Standard recovery time is 4-6 weeks of no HEAVY activity. Usual activity and 'taking it easy' for 3 weeks or so. No sexual relations for about 6-8 weeks to allow stitches to dissolve
neil_smith(C) My husband and I have a very unique and positive story with what we thought was kidney cancer. Dr. Shichman performed robitic surgery on my husbands left kidney the second week of January which turned out to be angiomyolipoma. We are very grateful to have Dr. Shichman do the surgery and blessed with the outcome.
mary_k(Q) What is the usual hospital stay required (if all goes well) fior a cardiac ablation? How long is the procedure?
Dr_Shichman(A) For most ablations you go home the same day or stay overnight. On occasion you need to stay 2 or 3 days. - Dr Zweibel
Nicole(Q) You have all giving me a great deal of guidence on choosing a robtic surgeon but first I must choose a medical oncologist - are the any that you yourself would recommened to someone you know and want to ensure that they got the best care?
Joseph_Wagner_MD(A) In order to make a recommendation, I need to know exactly what type of cancer you have.
Jean_Merz(C) Thank you so much for this wonderful telecast!
mary(Q) what is the risk of stroke during the ablation for atrial fibrillation? Is it riskier with or without robotics? How many has Dr. Zweibel done?
Dr_Shichman(A) The risk of stroke during an ablation for atrial fibrillation is considerably < 1 %. Dr. Zweibel has done over 50 ablations.
ssecca(Q) Is it possible that a 22 year old (my son) could have atrial fibrillation?
Dr_Shichman(A) Yes it is possible but not likely. He can have an EKG or a loop recorder to see. - Dr. Zweibel
Esa(Q) Excellent program! I would like to see school children become more motivated in the world of medicine and technology. Does HH conduct tours for school kids to learn more about robotic surgery and other procedures?
Joseph_Wagner_MD(A) We have had programs for area high school students that are involved with robotics. For instance, we ran a program for Avon last year. If you are aware of a program that is interested, I would be happy to facilitate.
chulla(Q) Dr. Shichman I am a Kidney patient of yours and I recently had Hernia Surgery and mesh was put in can I still get a CT Scan Or MRI
Dr_Shichman(A) yes no problem with either Ct or MRI
Marcy_D(Q) For the urology doctors: are there any patients who may not be candidates for robotic surgery.
Dr_Shichman(A) there are few absolute contraindications or reasons that a person cannot undergo robotic surgery
jonesgirl43(Q) Dr. Wagner -- what are the chances for metastasis if prostate cancer is found outside the capsule during surgery?
Joseph_Wagner_MD(A) If the margins are negative (meaning no cancer at the edges), the chance of developing spread is low.
jenpittman82(C) would the robotic surgery help a patient who has ureter cancer that is completely blocking the ureteron the right side. he has a nephrostomy tube to drain the kidney. the cancer has metastasis on the outside of the right lung. would robotic surgery be something worth looking into? he is in chemmo now because they can not get through the urter.
sandra(Q) Dr LaSala Is there much swelling post op from the robotic surgery?
Joseph_Wagner_MD(A) Minimal if any.
joy(Q) are all the heart ablations performed using the robotic, if not, how do you determine the best proceedure to use?
Joseph_Wagner_MD(A) Not all are robotic. It depends on the arrythmia and the patient.
stumarieg(Q) Is prostate removal appropriate for PIN?
Dr_Shichman(A) No not indicated
Marcy_D(Q) For the Gyn doctors: Are there any medical concerns ie: cardiac conditions, obesity ect. which would lead you to stear a patient away from robotic surgery.
Joseph_Wagner_MD(A) This is Dr. Lasla. Medical concerns always have to be taken in to account when considering surgery. Rarely conditions may make robotic better than open and vice-versa.
stumarieg(Q) Is prostate removal ever considered appropriate for medium to high grade PIN?
Joseph_Wagner_MD(A) No; it is not indicated.
Marcy_D(Q) Dr. LaSala, Besides smaller incisions what are the advantages to having robotic surgery versus laparoscopic or open surgery.
Dr_Shichman(A) Hi, it's Dr. LaSala answering: robotic vs. laparoscopic surgery is pretty much the same. Laparoscopic approach is a bit more difficult for the surgeon to perform, but if he/she is a skilled laparoscopic surgeon, it doesn't matter whether it's done robotically or straight-forward laparoscopically. Both are easier to recover as compared to abdominal approach
JOANN(Q) Are there other gyn procedures done robotically besides prolapse?
Joseph_Wagner_MD(A) This is Dr. Lasala. Other GYN robotic procedures include hystectomy both for cancer and non-cancer reasons, vaginal and bladder suspensions, and removal of fibroids.
Marcy_D(Q) Would robotic surgery be performed if a patient has had previous abdominal surgery and/or if a mesh has been implanted.
Joseph_Wagner_MD(A) I routinely perform surgery on patients that have had prior abdominal surgery; we have also performed surgery on patients with mesh.
galatea(Q) If the uterus is the size of a 6 mos. pregnancy with multiple fibroids and extensive endometriosis, would robotic surgery still be an option?
Dr_Shichman(A) that is super-tough. Again, depending on the surgeon doing it...you want someone with extensive experience. One could attempt to do it robotically, but with a high expectation that it will be converted to an abdominal incision
hhellstrom(Q) sorry , does the incontience sometimes not go away with time?
Dr_Shichman(A) yes it will usually decrease with time
wfsb(P) Please submit your final questions now, the chat is ending momentarily. Thanks!
JOANN(Q) Is cardiac ablation recommended for Arrythmias such as Bigeminy/Trigeminy?
Dr_Shichman(A) We can ablate ventricular ectopy but usually use medications first and only use ablation if they fail and the patient remains symptomatic. - Dr Zweibel
mike_a(C) Hello Dr. Wagner. Great show! Very impressive.
JOANN(Q) My father had surgery for prostate cancer 15 years ago. The prostate was not removed because the tumor was too close to the colon wall so the parts of the testes that had some cells were removed. His PSA has been pretty good since. However, considering the length of time and probable enlargement of the tumor, when this crops up again, would the robotics approach be an alternative?
Joseph_Wagner_MD(A) It is unlikely that he would be a candidate for surgery. However, if the PSA rises, he should see a urologic oncologist for discussion.
wfsb(P) Thank you everyone for attending the chat, have a great night!