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wristed instrumentation that allows greater mobility. Additionally, instead of hunching over an operating table, surgeons sit at an ergonomic console, where they control the platform's instruments. Dr. Samadi combines oncologic exper- tise with years of experience cultivated in each modality for radical prostatectomy to identify subtleties in each case few surgeons could pinpoint on their own. "My laparoscopic training strengthens every surgical procedure I perform," he says. "But the key to the program's success is that I also have extensive training in robotic surgical platforms and oncology. Knowledge of prostate cancer has changed dramatically in the past decades, and my job as an oncologist is to present patients with the latest research and offer them guid- ance to make the right treatment decision for themselves." The Genesis of an Idea During robotic prostatectomy training, Dr. Samadi learned the nuances of radical prostatectomy, including the conventional approach that emphasized opening the side of the prostate and suturing the dorsal vein complex. These procedural protocols were widely believed to prevent potentially catastrophic complications. SMART pros- tatectomy utilizes a different approach and does not require suturing the dorsal vein complex until the end of the procedure. Like many innovations, the idea for the SMART approach was conceived in a serendipitous moment and developed over a long period of hard work. "When learning open surgical techniques for prostate removal, sur- geons are taught to place the suture in the dorsal vein to prevent massive blood loss," Dr. Samadi says. "During one pros- tatectomy, I didn't place the suture, but there was no bleeding. Realizing that this didn't result in excessive blood loss, I thought about different approaches to prostatec- tomy. To reduce damage to the anatomy, perhaps we don't have to open the side of the prostate at all." Just as a n athlete studies ga me tapes, Dr. Samadi analyzed hours of prostatectomies — thousands of proce- dures — he had performed to identify an alternative approach and technique to improve upon traditional robot-assisted laparoscopic prostatectomy. "A simple modification to the conven- tional procedure — not opening the side of the prostate and waiting to suture the dorsal vein later in the procedure — allowed me to leave neurovascular bundles in place and avoid damage caused by cautery instruments," he says. "This changed the way I looked at prostatectomy. Instead of moving neurovascular bundles away from the prostate, I could move the prostate away from the nerves and cause less damage." "As an oncologist with years of open and laparoscopic surgical experience, I've combined the capability to recognize whether cancer is outside the prostate or not and developed a nerve- sparing surgery for optimal outcomes. It's like a high-rise building: The foundation is the oncological expertise, and the building itself is the laparoscopic skill. The penthouse is robot- assisted laparoscopic experience — the robotic surgical platform can't stand alone without that foundation." — David B. Samadi, MD, Chair of Urology and Chief of Robotic Surgery at Lenox Hill Hospital; Professor of Urology at Hofstra North Shore-LIJ School of Medicine The robot's tactile feedback affords an experienced surgeon the opportunity to successfully perform prostate removal while preserving continence and potency. David B. Samadi, MD, sits at the surgical console, where he will perform robotic prostatectomy from start to finish. M D N E W S . CO M ■ MD NEWS Long Island | 7

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