Dr. David B. Samadi, nowadays Director of Men’s Health at St. Francis Hospital, discusses the three main ways to remove the prostate: traditional radical prostatectomy (open surgery), laparoscopic prostatectomy, and robotic prostatectomy.
He also discusses the hybrid use of these surgeries: open surgeons use laparoscopic surgery, some open surgeons use robotic surgery, and some laparoscopic surgeons use robotic surgery. Dr. Samadi discusses the order of steps needed for success in training: open surgery, laparoscopy, and robotic surgery. Robotic surgeons need a foundation in oncology, open surgery, and laparoscopic training.
There are 3 ways to remove the prostate: The traditional surgery that Wane talked about, which is open surgery, laparoscopic prostatectomy, and robotic prostatectomy.
People always confuse laparoscopic prostatectomy and robotic prostatectomy. They really do not know the differences between these two and I will get into them. As a result of these 3 options, you will always find surgeons and urologists that have different expertise. If you talk to the open surgeon, he will still talk about how great the open surgery is. Not everybody likes change. Change has been a big name in politics nowadays. Some like change and some do not like change.
So, the open surgeons still think they have to stick to the original, traditional. Laparoscopic surgery comes from France and we will see some of those when the surgeon stays next to the patient and he uses these long chopsticks to remove the prostate. Robotic surgery is a remote control surgery. I sit here, the patient is in the back of the room and as I move the console, the robot performs the actions. But the whole operation is under the control of the surgeon. Not like a button you press, come back an hour later and the prostate is out!
You can also see some of the hybrids of these. So, we have the open surgeon who gets into laparoscopic surgery or we have the open surgeon who has skipped all the laparoscopic experience and took a weekend course to become a robotic surgeon. Or we may have a laparoscopic surgeon who moved on to robotic surgery without having the experience.
I started as an open surgeon. Then I went to France and became a laparoscopic surgeon and then a robotic surgeon. That is really the key to this. WE see a lot of robotic surgeons who may be excellent technicians with these robots but without the foundations of oncology and open surgery and without having the laparoscopic skills, this is not gonna cut it. Just being a robotic surgeon alone I do not think you should get much credit for it. So, starting as open surgeons we do a lot of surgeries. Typically, it is an incision and the surgery takes about 3 hours. Being an incision involved, blood loss was always a problem. It doesn’t matter who you are, how much experience you have, you are gonna lose blood and there is certainly a risk of transfusion. Surgeons who do these operations always put on magnifying glasses about 2,5 or 3 times and that is how it went for a long time.
Laparoscopic surgery appeared in France in 1999 and I got there for a year to learn the laparoscopic prostatectomy. So just imagine me and my partner doing this surgery. His name is Mike, the patient is in the middle. We have a camera, there is no incision. If Mike’s hand is shaking, the whole surgical field is moving. I have to see the surgical field, I have to digest it in my brain, I have to tell Mike to turn the camera and that is how the surgery went. That was a big advancement because there was no incision, blood loss was less but certainly, the learning curve was very steep and that is why many US urologists never captured this field.
Then came robotic surgery and we did 11 cases in France and then for 5 years at Columbia Presbyterian and after that at Mount Sinai.
We can see some of the advantages, with less blood loss. The camera is under my control, is 3 dimensional, I see it, my brain processes it, and I can do the surgery. I can navigate inside the patient’s abdomen the way and where I want to go.