Robotic Surgery Best, but Experience Still Matters

The increasing popularity of robotic surgery in treating prostate cancer brings heightened attention to the procedure itself. Medical studies continue to compare robotic surgery outcomes to laparoscopy and more traditional open surgery. Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, believes the robot is the way to go for prostate cancer treatment; however, he emphasizes, “experience is key.”

New findings from Weill Cornell Medical College in New York support the medical benefits of robotic radical prostatectomy surgery. The study reviewed the outcomes of 110,016 prostatectomy patients. Roughly 19% of those patients underwent robotic prostatectomy procedures, while the remaining patients had laparoscopic (21%) or open procedures (60%). Both laparoscopic and robotic surgery patients had less blood loss and shorter hospital stays. Further, each procedure delivered lower perioperative morbidity rates. Dr. Samadi explains, “Both have great advantages over open surgery. Smaller incisions and enhanced visibility allow me to see the cancer and remove the prostate through a much cleaner surgical field. With robotic surgery, the visibility is enhanced 10x with 3D imaging and the dexterity of the robot in my hands is very precise.”

Previous studies indicated the need for more than 1,600 cases to achieve acceptable outcomes

In this study, robotic surgery also had the fewest surgical complications. “While these findings support what I know to be true in my own practice,” continued Dr. Samadi, “I’m concerned by the conclusion they drew about experience. To say robotic surgery is easier to learn or proficiency can be accomplished in as little as 50 procedures is rather confusing. Previous studies indicated the need for more than 1,600 cases to achieve acceptable outcomes.” Using his own SMART (Samadi Modified Advanced Robotic Technology) procedure, Dr. Samadi employs the da Vinci System to cleanly remove the prostate and surrounding cancer. Dr. Samadi has performed over 3,500 successful robotic surgery procedures in the past 10 years, with a 97% cancer cure rate.

Dr. Samadi’s practice extends beyond U.S. borders. He often travels overseas sharing his prostate cancer expertise and performing live robotic prostatectomy procedures. “In many countries, including Israel and Italy, I see the desire for better prostate cancer treatment. Many times, they have the ability to purchase the robot, but simply don’t have the volume of cases we do. While the technology is in place and the surgeons are knowledgeable, they understand that time and experience are what it takes to become successful in robotic surgery.”

The study appears somewhat contradictory, as it also concluded that surgeons performing the greatest number of procedures, 1,000 or more, had the best outcomes. “This makes sense to me,” said Dr. Samadi, “robot or not, this is still medicine. Choosing an experienced surgeon is critical.”