Dr. Simon Hall: The question is, if a patient is undergoing a Radical Prostatectomy by a high volume, very skilled surgeon, whether it is open or robotic, aren't the outcomes of Open versus Robotic approaches essentially the same?
Dr. David B. Samadi: I think it's an excellent question and I think when you compare an expert open surgeon to an expert robotic oncologist, the oncological data comes very close to each other. I think the advantage in this is really the quality of life for our patients and we will review over the data later on, but I think the blood loss certainly is less.
Patients are staying in the hospital in a very short period of time, and I think this is the quality of life that we were talking about. And you have to convince me today, after watching this surgery, why I have to cut someone open. Because we are simulating the same open surgery, using a robotic technique.
Big prostates, big median lobes, prostates with 200 grams, can be removed without any difficulty. We are going back to the area where I was worried about doing the surgery and you can see this tissue right over the neurovascular bundle. And again, years ago, had we seen that suspicious tissue at the beginning of the case, the decision between me and my partner was, or any other oncologist, was perhaps we should take the whole nerve in order to give the cancer cure rate, and the rate of impotence was very high.
What you can see is, by this zooming mechanism of the robot, by the range of motion, you can really take millimeter of that tissue over the nerve without damaging it and our pathologists are ready during the operation to be able to look under the microscope for this tiny millimeter of tissue to tell us whether there is any kind of prostate or prostate cancer and that's extremely important. Because this is how you avoid and you can reduce your positive margin by not leaving. Right here, you may avoid a patient from going to have any recurrence or having radiation.
Now I can tell you that the positive margin for this tissue came back as no prostate and no prostate cancer, so we were fortunate enough to be able to leave that nerve alone.
Looking again at the final product, you can see that the prostate is completely removed. By this time, you have about 30-50 cc of blood during the surgery. The endopelvic is attached and the accessory one is there. The most surgical technique, which was used in skin cancer, is now being used here by removing the tissue as we explained.
Finally, the dorsal venous complex is repaired by a 3-0 Vicryl suture, instead of the old Vicryl that can kind of like squeeze the dorsal vein and change the anatomy. Now what's really important here is since the neurovascular bundle have been moved to the side, you are not enclosing that or entrapping it in your suture and I think there were a few areas in open surgery or laparoscopic where we were damaging the neurovascular bundle. One was opening up the endopelvic. The other part was placing this suture during the dorsal venous complex and finally during anastomosis. So, the attention has to be really given to this and one has to be careful.
I am introducing you, the Minimal Invasive Robotic Technique, or MIRT, which is the method for 2008 robotic technique, and the concept behind this is, the less you do, the better off you are and the better the quality of surgery is going to be for your patients.
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