Q: Do you do the entire surgery yourself, from beginning to end?
Yes, I am present throughout and conduct every step of the surgery. The use of the word robotic is sometimes confusing to people. I am assisted by the robotic technology, but the machine, which is merely an advanced aid, could never function without me. I perform every step of the operation myself.
Q: How is the robotic program at Lenox Hill different from other hospitals?
If you choose me as your surgeon, you’re getting three doctors in one. Let me explain what I mean by that. I’ve performed traditional (or open surgery), laparoscopic surgery, and robotic surgery. I bring all 3 methods to my practice and each builds on the next. Another hugely important difference is my staff. The team I work with has been with me for 7 years. They get to know our patients and work with them through every stage of the process. They attend to patients before, during and after surgery. It is uncommon to find this level of consistency and personal care and it’s exceptional to get this level of expertise from a surgical staff.
Q: How is the da Vinci system controlled by the doctor?
Controlling the robot is really simple and intuitive. The doctor sits at a console in the OR and watches the movements of the robot on a 3D high-definition monitor. The miniature surgical instruments are manually controlled with joysticks. These help replicate our movements in real time, performing incisions and sutures of high detail. The robot’s arms are much more flexible than the human hands and can move in any direction with extreme accuracy and precision. Read more on the da Vinci Robotic Prostatectomy
to understand its inherent benefits over other forms of prostate cancer surgery.
Q: If the da Vinci robotic system were to fail during surgery, what would you do?
Only once in the past three years has that happened. I was able to complete the case laparoscopically without needing to open the patient’s abdomen. By way of analogy, if a pilot’s automatic landing systems fail, he or she will land the plane manually and will have been trained to do so. For this reason, it is important to be skilled in open, laparoscopic and robotic surgery.
Q: Why is volume, or number of surgeries performed, important in choosing a surgeon?
I am a specialist in prostate and bladder surgery. I’ve performed over 7,000+ surgeries to date. Nothing I see while operating is unusual or unfamiliar. I have witnessed everything that may possibly occur. The terrain of my chosen field is intimately and thoroughly understood by me so that any guesswork is completely absent from the equation.
Q: In open surgery, you rely on your sense of touch. Is it hard to operate without it?
Open (traditional) surgeons argue that the sense of touch is important in guiding them through the surgery. It’s inherent that blood pools at the surgical site in open surgery. It makes it very difficult to see and it feels like walking blind to me. I much prefer the visual clarity and the consequent precision gained from robot-assisted surgery. In the SMART technique
I developed, due to using 8-10 mm instruments, the incision is barely noticeable and the blood is minimum. The robot allows for enhanced vision and angles of dissection not possible with open and straight laparoscopic instruments.
Q: If I decide to go with radiation instead of surgery, can I have surgery later, if the radiation treatment is unsuccessful?
Surgery is not an option after radiation treatment. However, the reverse is possible. If you choose surgery, and your doctor determines after the operation that the cancer has returned, you may, at that point, choose radiation. Radiation depletes the body and weakens its immune response.
Q: What, in your opinion, what is the greatest benefit of robotic surgery?
Open surgery is considered successful when the cancer is removed even if it means the patient is left incontinent and/or impotent. I consider robotic surgery successful when the cancer is cured, and the patient has full continence and potency. All 3 categories must be met for me to consider the surgery a success. This means quality of life is at its highest.
Through the SMART technique, we’ve achieved the following statistics:
- 89% of patients are cancer-free, with less than 2% seeing a recurrence of cancer 1 year after surgery;
- Urinary continence for within 12-13 months of surgery among patients who experienced normal continence prior to surgery;
- Sexual potency for 83% of patients who experienced normal sexual function before prostate surgery.