The Evolution of Prostatectomy

Robotic Prostate Surgery The Mount Sinai Medical Center Introducing Dr. Samadi and Robotic Prostatectomy Dr. Simon Hall: Dr. Samadi is a fellowship trained Urologic Oncologist. He also had further training in Laparoscopy and Robotics. He has performed many live surgeries, both nationally and internationally. He worked closely with Dr. Abbou in France to perform some of the first Robotic Prostatectomies in that country. He has parted many, many Urologists in the United States in Robotic surgery and has performed over 1,400 Prostatectomies today. Dr. Samadi -- Dr. David Samadi: Thank you very much for that kind introduction. It's a great privilege and honor to be here. I would like to speak to many of our Urologists out there, who are interested in developing a robotic program, as well as our patients who have gone through this. Perhaps, you can see some of the procedures and look at the data. Perhaps, if you have newly diagnosed prostate cancer, this is a very exciting time in Urology. As you can see, I am going through the journey of what has happened to me as a surgeon, at least, over the past decade. I started by experiencing and going through the Open Prostatectomy and open surgical skills. Certainly, many years ago, I thought this was probably the best option for the patients by removing the prostate. However, there are issues with Open Prostatectomy and there is an incision involved. When you have an incision and you have a retractor that's open and stretching the muscles, there are pain involved in this procedure. The blood loss was an issue and even though we are improving our techniques in Open Surgery, still many of the patients were getting transfusions and as a result, there was a longer recovery. I think, it's important to keep that in mind because this is really the foundation of our science. Whatever we have learned from Open Surgery, we have moved on to Laparoscopic Prostatectomy. Now people ask why or what's the rationale from going to Open Prostatectomy through Laparocscopy? Simple, you are making a 7 inch incision in order to remove a small walnut organ. Perhaps, the size of the incision is not proportionate. If you go to a keyhole surgery, such as Laparoscopic Prostatectomy, which developed in Europe, especially in France, this would be a less invasive procedure. The surgeons stands next to the patient and using the long, rigid instruments, we are able to remove the prostate. Certainly, this was a big advancement in the field of prostate surgery. I was fortunate enough to be working with the pioneer in the field; my friend and colleague Claude Abbou. However, we realized early on that since we are using one camera, there is only a two-dimensional view and you are losing the depth of perception. As a result, we got involved in the robotic technology. The advantages of robotic surgery is that you would have a similar range of motion as your arms. So you will have a six degree of freedom. You can certainly sit comfortably at a distance from the patient and you would be able to do your operation, not only with a three-dimensional view but you would have the 10 to 12 times magnification. Now the purpose of this webcast is really not to say, which one is really better than the other one. I think the patients that are coming to Mt. Sinai and they are seeking our expertise, they would like to have this three surgeons in one head. They would like to see taking the experience of open surgery, bringing the Laparoscopic skills and use the technology of robotics. So it's really the marriage of the three fields of science, skills and technology. That safety and security for our patients is extremely important. Here you are looking at the video of a Laparoscopic Prostatectomy from years ago and you can see that you are working in a bloodless field. Certainly, you can see small capillaries going to the seminovesicle clearly. One can clip them instead of tearing them, as we had in open surgery, and be able to dissect the procedure. The learning curve for Laparoscopic Prostatectomy is very steep, as you know Simon. Certainly, many Urologists in this country never really develop that skill and I really don't think this Laparoscopic Prostatectomy will pan out to be the treatment of choice. As we can see, robotic surgery has become more and more common. The view of this surgery in the operating room is such that the surgeon sits at a distance from the patient. The whole operation is done entirely by myself and it's under my control. There is no such thing as a button that you press and the robot would go to work. So that's important for the patients to know. The movements of the surgeon's hands are translated to the tip of the instruments and as a result, you can do a precise, bloodless operation. Advanced DVP Technique Training Program available. Mini fellowship for Da Vinci Prostatectomy. Two-day hands on course covers: 1. Setting up the team 2. Efficiency in the operating room 3. Building a successful program and its infrastructure 4. Review of your difficult cases 5. DVD's, trouble shooting, and improving quality of cases To find out more about our Advanced DVP Technique Training Program or if you are a newly diagnosed prostate cancer patient, please contact Unknown Speaker: by calling: 1-888-444-2312, emailing: robotmd@aol.com, visiting: www.roboticoncology.com.