NEW YORK, July 26 As the surgeon behind the robot, Dr. David Samadi, Chief of Robotics and Minimally Invasive Surgery at the Mount Sinai Medical Center in New York City, builds on oncologic principles learned with open radical prostate cancer surgery and transferred to a robotic approach. He calls this approach the SMART Surgery Technique (Samadi Modified Advanced Robotic Technique). He employs this technique at Mount Sinai where he recreates the traditional open anatomical surgical technique on the robotic surgery platform for prostate cancer treatment.
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As a trained fellow in both urologic oncology and laparoscopy, Dr. Samadi uses robotic surgery as a tool that gives him ease of movement, increased magnification and visualization as well as extraordinary dexterity, precision and range of movement. Hand controls maneuver the EndoWrist® instruments in the da Vinci® S HD-Surgical System Robot which offer him unparalleled 360 degree range of motion. Foot pedals allow him to make the camera inside the patient zoom in and out, giving him a high definition 3D view of the prostate, nearby organs, nerves and blood vessels.
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"The SMART technique is an advanced technique that should not be performed early in a robotic surgeon's learning curve," advised Dr. Samadi. Since 2003, Dr. Samadi has performed more than 3,000 Robotic Assisted Laparoscopic Prostatectomies (RALP); about half were done using the SMART technique. With the da Vinci robot and the SMART technique, Samadi is able to help his patients achieve continence rates of 97% and potency rates of 81% at 1 year, while giving them a 95% cure rate.
Dr. Samadi's SMART technique can be performed in 2 hours or less. It is a complicated prostate surgery procedure that involves dropping the bladder, transecting the medial and posterior bladder neck and dissecting the seminal vesicle. After this is completed, then Samadi tackles the main, yet intricate part of the procedure: removing the prostate while sparing the surrounding nerves. After the dorsal venous complex (DVC) dissection, the prostate is removed and bagged and the DVC is sewn up. The bladder neck is reconstructed and the procedure is finalized.
"What's important to note is that since there is no suture in the DVC, it results in a longer length of urethra, which results in better continence and less chance of nerve damage," explains Dr. Samadi. "Since there is minimum dissection performed on the sides of the prostate, there is less chance of damaging the nerves responsible for sexual function, which means a better sex life because the sexual function is ultimately improved."
Because of the intricacy of this technique, surgical experience is paramount. As evidenced in a report by Dr. Samadi in the July issue of the Journal of Endourology ("Improvements in Robot-Assisted Prostatectomy: The Effect of Surgeon Experience and Technical Changes on Oncologic and Functional Outcomes"), "increased surgeon experience with RALP results in improvements in oncologic and functional outcomes." Also aiding the positive outcomes are modifications to the robotic technique, such as with the SMART technique, as well as nerve sparing techniques. "However, these techniques also add to the learning curve of the surgeon, which again highlights the importance of volume and experience in this type of surgery," explained Samadi, "even difficult operations become routine with the robot and the SMART Technique."
The benefits of da Vinci robotic prostatectomy are inarguable: shorter hospital stay, key-hole incisions, little pain, low risk of bleeding and infection, quick healing, small scars, and minimal risk of becoming impotent or incontinent. "This robot and my SMART Technique allows me to be even more precise with eliminating prostate cancer," says Dr. Samadi. But make no mistake the surgeon is control, not the robot. "The surgery is not computer programmed and each one is treated as a unique operation," explained Samadi.
As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, Dr. Samadi specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. Samadi is fellowship trained in laparoscopy and robotic prostatectomy surgery and is an internationally recognized expert in both fields. "However, robotic prostatectomy is the most thorough prostate treatment that removes the prostate gland, which allows for accurate staging and grading and cure," says Dr. Samadi, "It reduces complications and assures a better quality of life."
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SOURCE RoboticOncology.com
