Da Vinci Robotic Prostatectomy
This 3-D diagram shows the robotic surgical theater with a model of a da Vinci Robotic System. People sometimes misunderstand the robotic system because of its name, thinking it performs the surgery on its own. In fact, the da Vinci surgical system merely assists with the removal of the prostate gland while a surgeon conducts the surgery every single step of the way.
Accessing the Prostate Gland
Dr. Samadi demonstrates how to mobilize the bladder during robotic prostate surgery in order to reach the prostate. The video clearly shows the da Vinci robotic instruments at work. Dr David Samadi explains the defatting of the endopelvic fascia. This portion of the prostate removal surgery is performed under the pubic bone, which would be very difficult to see during open or traditional surgery.
Bladder Neck Dissection
In this video, Dr. Samadi explains why he opens the bladder neck early during robotic prostate surgery. He says it’s important to stay away from lateral tissues during this prostatectomy procedure. At Mt. Sinai Medical Center, Dr. Samadi says he’s fortunate to work with the latest version of the da Vinci robot, which gives him a fourth arm for increased function. The bladder neck dissection is necessary to separate the prostate from the bladder so that the cancerous prostate gland can be removed.
Vas Deferens, Seminal Vesicles
Dr. David Samadi uses surgical clips near the vas deferens during da Vinci robotic prostate surgery. Dr. Samadi recommends relying on visual feedback to prevent tearing of the delicate seminal vesicles during a robotic prostatectomy. After performing many surgeries, Dr. Samadi says surgeons can expect to gain a sense of tactile feedback from the da Vinci robot during surgery to remove the prostate.
In this video, Dr. Samadi points out the posterior part of the prostate, or Dennonvilier’s fascia, during a robotic prostatectomy. Samadi says he’s certain that da Vinci robotic technology is the future of prostate surgery. One of the great improvements made possible by robotic surgery, according to Dr. Samadi, is the increased range of motion that allows for improved nerve sparing during prostate surgery.
Neurovascular Bundle Preservation
The focus here is nerve sparing during robotic prostate surgery, an area of expertise for Dr. Samadi. Not severing, or sparing the nerves, helps preserve sexual function. Dr. Samadi points out the base of the prostate gland in this video and talks about the small amount of blood lost during robotic prostate surgery in comparison to open surgery.
Endorectal MRI / Sural Nerve Harvesting
Pre-operative planning before prostate surgery is discussed here by Dr. David Samadi of Mt. Sinai Medical Center. For high risk prostate cancer, Dr. Samadi advises patients have an endorectal MRI before a prostatectomy operation. He explains the procedure for sural nerve harvesting that’s used when the nerves cannot be spared because the prostate cancer is too advanced.
Minimally Invasive Robotic Technique
In this video, Dr. Samadi points out the neurovascular bundle during an actual prostatectomy operation. Dr. Samadi says the less you manipulate these nerves, the better the chances patients will retain sexual function after prostate surgery.
Posterior Bladder Neck Reconstruction
Reconstruction of the bladder neck during a radical prostatectomy is demonstrated here by Dr. David Samadi. He suggests leaving a long urethral stump because it helps prostate cancer patients maintain urinary continence after prostate surgery. Dr. Samadi also believes the posterior bladder neck reconstruction using the da Vinci robotic system also helps preserve post-surgical continence in men who’ve had their prostate glands removed.
Dr. Samadi demonstrates here how to reconnect the bladder to the urethra after the prostate gland has been removed for a robotic prostatectomy. Samadi`s method is to use a single suture and a curved needle for this procedure.
Rules of Ones
Dr. Samadi takes a moment to explain his “rule of ones” that applies t0 robotic prostate surgery at Mt. Sinai Medical Center. Patients can expect a robotic prostatectomy to take approximately one hour and to stay in the hospital just one day. Dr. Samadi says robotic surgery under his care means the catheter stays in after prostate cancer surgery for just one week and patients can expect recovery from robotic prostate surgery to take one month.
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Successful Robotic Program
The key to a successful robotic surgery program, according to Mt. Sinai’s Dr. David Samadi, depends on far more than experienced surgeons. Samadi says the surgical team at Mt. Sinai is tight, expertly trained and highly experienced. On a final note, Dr. Samadi says patients who choose to have prostate cancer surgery with him benefit from his extensive experience in robotic prostate surgery.
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* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.