SMART Surgery and How it Improves Sexual and Urinary Function

Dr. David Samadi invented the SMART Surgery Technique (Samadi Modified Advanced Robotic Technique) by using the oncologic principles for prostate cancer treatment he has learned in his long career and combining them with his open radical prostatectomy skills. He then took those two skill sets and applied them to a highly nerve-sparing robotic prostatectomy approach, which he employs as the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. The results are robotic surgery that provides a complete prostate cancer cure along with increased sexual and urinary function.

The SMART Surgery Technique is basically a traditional open anatomic surgical technique performed on the robotic platform. “Ideally, I found that knowing how to perform an open surgery and then laparoscopic surgery helped add to my skills as a robotic surgeon,” explained Dr. Samadi, “This is why I feel that these are steps that all robotic surgeons should follow in order to obtain the experience to perfect their robotic prostatectomy skills.”

Dr. Samadi uses Intuitive Surgical’s da Vinci robot with its high definition 3D view, miniature EndoWrist® instruments, and manual controls to help him perform the intricate SMART robotic prostate surgery. The robot helps him detach the prostate while sparing the nerves that control sexual function and continence. “These skills take time for a surgeon to master and when it comes to robotics, volume adds to a surgeon’s experience,” he explained.

The nerves that control sexual function, and the urinary sphincter, responsible for continence, are within 1-2mm of the prostate. The robot allows Dr. Samadi to preserve the urethral length and restore a watertight reconnection of the bladder to the urethra with less scarring. Urinary control can be regained within days of surgery to up to 12 months. However, many of Dr. Samadi’s patients regain urinary control within the first few weeks. Permanent incontinence is rare. Sexual function recovery varies also from days after surgery to up to 2 years.

The da Vinci robot helps accurately remove the prostate with precision nerve sparing

“Older prostate surgery techniques had surgeons working blindly, solely by touch, which is a complete contrast to the high definition 3D magnification that the robot provides,” said Dr. Samadi. The da Vinci robot allows Dr. Samadi to operate in a relatively bloodless field to help him accurately remove the prostate with precision nerve sparing. Because of the improved visibility and the robot’s precise surgical control, Dr. Samadi is able to see, in great detail, the nerve bundles that he wants to preserve. He is able to not only provide a cancer cure, but by preserving these nerve bundles, he can restore continence and sexual function.

By minimizing injury to these delicate nerves and surrounding areas, the athermal SMART Surgery Technique has proven success rates in men for normal sexual and urinary function. Dr. David Samadi, who does not believe in running numerous simultaneous operating rooms, performs the entire surgery from beginning to end. His patients experience a faster recovery and usually spend just one night in the hospital; most are discharged the next day. Because of reduced blood loss, smaller incisions and less pain, patients can typically walk the day of their surgery, which is why patients fly in from all over the world for Dr. Samadi’s “personal touch.”

“I know how important a cure is to my patients, but I also know how important it is for them to be able to not experience incontinence after a prostatectomy and to be able to regain sexual function after prostate surgery,” explained Dr. Samadi. “The SMART Surgery Technique allows me to give my patients all three of these important factors successfully.”