USC Dr. Friedman

[Cityview]

A few months ago I had a telephone consultation with Dr. Friedman. I have spoken to him a couple of times. He seems very nice. I would like to publicly thank him for the time he has spent with me on the telephone.
I asked him how long the middle fossa surgery would be. He said two to three hours. I also asked him how long retrosigmoid surgery would take. He said the same amount of time, two to three hours. My tumor is small, but this seems fast. Does anyone have any ideas why retrosigmoid surgery at USC would only take 2-3 hours? My doctor in my home town said it would be an eight hour surgery for me.
Doctors always have different opinions, but this estimate of time seems far outside of the norm from what I can tell from my research.
I asked this question on the ANA webinar "Ask the doctors". You can listen to the webinar to hear their response.
I would appreciate any thoughts from the community.

[researcher]

You might want to ask how long you will be under anesthesia.

[caryawilson]

How does the experience between the two doctors compare? I don't know Friedman at USC, however, he has many high recommendations from this site. I would say he is the second most popular after the doctors at House. I would put more faith in the USC estimate. 8 hours is the standard AN surgery estimate.

[researcher]

RS and MF surgeries are usually done by 2 doctors. One to open the internal auditory canal and the other to remove the tumor. I wonder if the doctor was quoting their time on their part of the surgery. So 2-3 hours for each part.

I am probably not describing this very well. That's a lingering problem for me since my surgery. It's hard to express myself. Good luck to you! Definitely keep asking your questions of the doctors.

[michellef08]

My tumor was 1.4cm and my Middle Fossa surgery (with Dr. Friedman and Dr. Schwartz) took 5 hours, although that was 3 years ago. 2-3 hours seems short to me, but Dr. Friedman is a smart guy, so I'm sure he had a reason! Maybe your tumor is not stuck to the facial nerve, so it would be easy to remove? Mine was "sticky to the facial nerve" so Dr. Schwartz had to come at it with a bunch of different tools from different angles. Or maybe because it is small? You may just need to clarify with him if you seek treatment there down the road.

[researcher]

Thank you , Cityview! Take care.

[UpstateNY]

When I was researching different physicians for my translab surgery, Dr. Friedman told me the surgery would take 4 hours and the House told me 5-6 hours, so the different times you received are not surprising.  Since I decided on having the surgery at the House, I did not dig into Dr. Friedman's time any further, but suspect the difference could be the speed of surgeon or what they consider the surgery to include. 

For example, my surgery ended up taking 6 hours from when I was put under until when I woke up in the ICU.  Figure there was some time spend harvesting the fat, prepping me, and cleaning me up, so the actual surgery was probably closer to 5 - 5.5 hours.  If I break this down further, the actual tumor removal by Dr. Schwartz took 1 hour, since my wife was notified when he started the tumor removal and when it was completed, which means the opening/closing took about 4 - 4.5 hours.

I would suggest confirming with Dr. Friedman exactly what he considers the surgery time to include.  He is very good about answering any questions one has. Also keep in mind that Dr. Friedman only performs the open/closing, not the tumor removal.

[Sheba]

Hi all

I agree with @Researcher, the best question is how long will you be under anesthesia.

I asked this of Dr. Friedman as well as 3 other docs.  Dr. Friedman provided the shortest time estimate, 3.5 hrs, vs. others saying 5-6 hrs for 1.4 cm tumor.

Dr. Friedman works with neurosurgeon Dr. Steven Gionnatta, I just saw this blog item from Dr. Gionnatta re: length of AN surgeries:
http://www.stevengiannottamd.com/blog/

It seems Friedman and Gionnatta are very focused on having "industry leading" statistics on positive outcomes and shorter stays in hospital, which relies on minimizing post op complications.  I know all doctors focus on this, but it seems F/G/Keck AN Center are very transparent / publishing outcome and cost stats relative to the rest of university health care hospitals/AN programs.  Shorter anesthesia is one of the predictors of better outcomes - of course the time to remove tumor is largely influenced by size and location of tumor, but it seems like they may be finding some ways to streamline the process a little in the OR???  I don't know exactly "what" they are doing differently than other leading AN surgeons, but Dr F attributed it more or less to their focus on ANs and being a very experienced and skilled team - not his exact words but my interpretation.

I did ask a different neurosurgeon about why it may require 5-6 hrs under anesthesia, and he explained that during the tumor resection, any time the nerve monitors show any stress on a nerve (auditory, facial etc.), he will "let it rest" for a while and work on a different part of the tumor.  It's hard to predict how often this will happen during the surgery, but his preference is to be conservative during the removal. 

So maybe there is some nuance about how to maximize post op results - balancing between "resting" the nerves during surgery vs. minimizing total anesthesia time.

@Cityview - you mention possibly that part of the total downtime is due to one of the surgeons not actually being available as soon as you are "ready" in your procedure -- yikes !!  I hope that is not possible, that they'd just let you sit there for 30 minutes or an hour under anesthesia, because they are "multi tasking" between patients on the same day.  I will have to ask if any of the docs I am talking to would ever do that !! 

[michellef08]

When I had my surgery at House (3 years ago) with Dr. Schwartz and Dr. Friedman, they definitely didn't double-schedule them for surgery. They did perform 2 surgeries on the same day - but I was the morning surgery, and a lady had the afternoon surgery. We were on the same track for pre-op appointments, ICU stay, and post-op appointments so we spoke with them frequency.

[Citiview]

I had a follow up talk with Dr. Friedman to ask about the surgeries. He did confirm the average length of surgeries at USC Keck to be the following: under 3 hours for a middle fossa and under 4 hours for a retrosigmoid. That's time under anesthesia and those are institutional stats straight from a conversation with him. He said those times are recorded by their physician's assistant.

I also asked how many surgeries he and Dr. Giannotta have performed together at USC Keck Acoustic Neuroma Center since its opening in 2013. His answer was 200.

It was a nice, cordial discussion. I like Dr. Friedman. He was able to answer a lot of my questions.

I'm trying now to think about this illness less and enjoy life more.

I just wanted to share the follow up information.