Prostate Cancer -

April 07, 2010 16:03 ET

Prostate Cancer Treatment Surgeon Dr. David B. Samadi, MD Describes How Robotic Surgery Helps Doctors to "Feel With Their Eyes"

NEW YORK, NY--(Marketwire - April 7, 2010) -  A common criticism of robotic surgery is that the lack of tactile feedback inherent to use of the da Vinci robot compromises the surgeon's ability to control the surgical outcome. Dr. David B. Samadi, Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center in New York, says this could not be further from the truth. New research from the New York-Presbyterian Hospital/Weill Cornell Medical Center has proven this by determining that the robotic technology offers superb visualization, which more than compensates for lack of tactile feedback, resulting in improved positive surgical margin rates for robotic surgeries.

The U.S.-led team of physician scientists found that the lack of tactile feedback during robotic prostate cancer surgery did not adversely impact outcomes. Dr. Samadi described the study as a "positive validation" of what he has known for many years. "With its three-dimensional, high-definition view, the robot gives surgeons the sensation of touch, even as we operate from a remote console," said Samadi, who has successfully performed over 2,500 robotic prostatectomy procedures in his Manhattan practice.

The robot offers 11x magnification and 3-dimensional view, resulting in a phenomenon described by the study's authors as "intersensory integration." This phenomenon provides the surgeon with anatomical details and visual cues "that not only compensate for lack of tactile feedback, but actually give the illusion of that sensation." These cues include the color of tissue, the location of veins, which, in turn, mark the location of nerves, signs of inflammation, and acknowledgement of important compartments outside the prostate. The research appears in the British Journal of Urology International.

Surgical outcomes for minimally invasive robotic prostate cancer surgery compare favorably with traditional invasive (open) surgery. Dr. Samadi is an expert in both fields, in addition to laparoscopic surgery and oncology. In addition to his 2,500 robotic prostate cancer treatment cases, he has successfully performed 200 traditional and 300 laparoscopic surgeries. The study also identified many visual cues that surgeons can use to improve clinical outcomes. These outcomes not only include a cure, but also faster recovery, less blood loss, and retention of sexual function and continence.

"I can speak confidently about 'intersensory integration' because it is something that I have developed in my years as a surgeon," said Dr. Samadi, "The use of robotics allows for reduced hand tremors, but inexperienced surgeons feel uneasy with this lack of touch. However, with intersensory integration, the surgeon's vision replaces their sense of touch."

"With my experience as an oncologist, I can view a tissue sample and predict its pathology, which allows me to zero in on the abnormal area within the prostate," explained Dr. Samadi. Samadi believes it is a natural by-product of only the most experienced robotic surgeons, who have handled a large volume of cases, like he has. "Working in a pool of blood reduces visibility and creates a higher risk of damaging the surrounding tissue, resulting in nerve damage and possible damage to the sphincter," continued Samadi. "In robotic surgery, surgeons can see better since there is less blood in the field, which is why 'tissue recognition' is more important than the tactile feedback needed in open surgery."

"I treat each patient individually, getting as much as information from the prostate-specific antigen (PSA), digital rectal exam (DRE), Gleason scores, in addition to the biopsy and/or MRI imaging. So with my experience, I can determine how best to treat the patient and then refine my approach during the actual surgery if cues indicate I need to," said Dr. Samadi. "I've always said, time and time again, the robot doesn't do the surgery -- the surgeon does; successful surgical outcomes should not be dependent on technology alone."

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