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Turning the Procedure Inside Out Prostatectomy requires a high degree of dexterity to reach the gland and meticulously separate it from surrounding critical structures. "During prostatectomy, surgeons peel the nerves responsible for sexual function and continence away from the prostate to remove the gland," Dr. Samadi says. "But the less we do to the nerves, the less risk for complications there will be." The SMART technique mitigates com- plication rates by inverting the process. "I approach from above the prostate and remove the gland without disrupting the nerves encapsulating it," Dr. Samadi explains. "Whereas conventional laparo- scopic prostatectomy utilizes an outside–in approach, SMART prostatectomy uses an inside–out methodology, avoiding damage to surrounding nerves and tissues. This is how I achieve 96 percent continence and approximately 80 percent preserved sexual function rates." These rates were documented in the July 2010 issue of the Journal of Endourology, in an article comparing the SMART technique with procedures that included the dorsal venous complex suture. The article also noted that "increased experi- ence with robot-assisted prostatectomy resulted in improvements in oncologic and functional outcomes." Through six small keyhole incisions, Dr. Samadi introduces da Vinci instrumen- tation to the surgical site. After bilaterally incising the median umbilical ligament to the vasa deferentia and bringing down the bladder, he reaches the retropubic space, where he exposes the prostate and severs the gland's connection with the bladder. Dr. Samadi cross-clamps and cuts both vasa deferentia to facilitate dissection of the seminal vesicles — components of the neurovascular bundles. To spare the nerves, Dr. Samadi rotates the seminal vesicles away from the prostate's surface, minimizing traction on the neurovascular bundles. After this step, Dr. Samadi uses blunt dissection with curved instrumentation designed for the da Vinci Surgical System, alleviating the need for cautery devices. With critical structures no longer obstructing access to the prostate, Dr. Samadi removes the gland from the urethra and rejoins the neck of the bladder to the urethra. Built for Precision and Speed SM A RT prost atec tomy reduces operative time to approximately one to one-and-a-half hours and does not requ ire blood t ra nsf usion. In t he nearly 6,000 SMART prostatectomies Dr. Samadi has performed, his patients have never suffered complications, such as rectal perforation or reoperations, associated with laparoscopic approaches. ABOUT DR. SAMADI DAVID B. SAMADI, MD, Chair of Urology and Chief of Robotic Surgery at Lenox Hill Hospital, and Professor of Urology at Hofstra North Shore-LIJ School of Medicine, is a board- certified urologist and oncologist who specializes in diagnosing and treating urologic diseases. He focuses primarily on minimally invasive treatments for prostate cancer and leverages his expertise in laparoscopic and robotic-assisted laparoscopic approaches to minimize postoperative side effects, such as incontinence and sexual dysfunction. BUILDING A SKILLSET Dr. Samadi earned his medical degree from the State University of New York, Stony Brook School of Medicine. Upon the completion of a residency in general surgery at Montefiore Medical Center and another residency in urology at Albert Einstein School of Medicine, he completed an oncology fellowship in urology at Memorial Sloan Kettering Cancer Center. During his oncology fellowship, Dr. Samadi traveled to France, where he honed his robotic-assisted radical prostatectomy skills at the Henri Mondor Hospital Créteil, under the tutelage of Professor Clément-Claude Abbou. GLOBAL REACH Many Americans may quickly recognize him as part of Fox News' Medical A-Team, but Dr. Samadi has also had a profound influence on the global stage, traveling to Greece, Israel, the Netherlands, the Dominican Republic, Germany and France to train surgeons on robotic platforms. Dr. Samadi performed the first robotic-assisted prostatectomy in the Dominican Republic, and in early 2014, he returned to the country and joined President Danilo Medina in inaugurating the Samadi Robotic Surgical Institute at the Hospital Metropolitano de Santiago — a specially designed, four-room facility where extensively trained surgeons use the da Vinci Surgical System to provide surgery to patients from across the Caribbean. Dr. Samadi and his surgical team have been operating together for a decade. COV ER FE AT UR E 8 | Long Island MD NEWS ■ M D N E W S . CO M

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