Dr. Simon Hall: So what are the patients who can't have a robotic prostatectomy, so specifically, obesity, prior surgery of the abdomen. So I think we have had three questions on that. So could you just answer that question at this point.
Dr. David B. Samadi: Well, that's a very good point and what's important is that anyone, that would be a candidate for open surgery, would be a good candidate for robotic prostatectomy in our hands. Obviously, like what I said, you have to know your patients, you have to pre-plan and no surprises in the operating room. I am going to go over some of the challenging cases and review it in a minute, Simon.
A lot of people would ask us, how can you make the transition and really perform 600-700 cases within 13 months and the key to a successful robotic program is not just the surgeon. I can't take all the credit for myself as much as I would like to, but you need to have the support of the hospital, from the CEO to Administration, to the Chief of Urology; that would create an environment that you can stay focused.
You have to go through the expertise in training. You obviously, need to have the team. These are the guys that are working extremely hard and there are few people that are not in this picture and I would like to take this opportunity to thank everyone of them. What we have at Mount Sinai, is a coverage. There are people involved before the surgery, there is a team in the operating room that are always with me and there is a team that will take care of you afterwards.
To me as a surgeon, that's extremely important and I want to give you the comfortable environment that would be cured of cancer and with the dedicated staff that we have. As you can see their volume has grown rapidly, this is our volume over the past few years and the estimated number in 2008, it's going to be a little over 600. I can tell you that I perform the surgeries from the beginning to the end myself.
A lot of my patients have read about my background. There is a moral and ethical bond that goes between myself and the patients. When you come to Mount Sinai, you can be assured that I am there from point making the incision to finishing up your surgery and you are coming for the expertise and that's a very important point for people to know.
Now going back to your question Simon, we have seen a lot of patients and complex cases coming in among this 1400 cases. Certainly, patients with previous midline abdominal incisions, patients who have had colon resections; that's when your laparoscopic skills comes very handy and it's important.
We know that patients with laparoscopic hernia repair with mesh, would make the open surgery almost impossible. The trick to this is really to stay below the mesh and dive down over the prostate and be able to avoid that. For patients who have had previous TURPs, Microwaves and TUNAs, you have to play it safe. So what I do is, I put in two Double-J stents before the operation in order to protect them and you can remove it at the end.
Large medium lobes, large prostates, certainly patients who have had radiations in the past, we have performed radiation failure using this technique and there has been a case of robotic surgery, where a surgeon spends six hours and was not able to perform the operation, came in for a second opinion. I was able to go back in, these are complex cases and was able to remove the prostate in a Jehovah's Witness, that the blood loss was very critical and he is done very well and certainly obese patients, I like to keep it with a body mass index of 35-38 and we will have a little discussion about that.
Dr. Simon Hall: So in general to sum up, there is really across the board not anything that will completely rule out a patient, it's on a case by case situation.
Dr. David B. Samadi: Exactly right and I think you have to individualize the care of every patient and assess them way ahead of time so there won't be any surprises.
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