A few decades ago, it was predicted that robots would bring about a revolution
in all fields of surgery and even take over for the doctor, who would take only
a supporting role in the operations. That prediction was exaggerated, as so far,
the amazing devices are used only in general surgery, orthopedics, gynecology
and urology. But in those specialties, they indeed have brought about
significant improvements – less pain and bleeding, faster recovery, greater
accuracy and fewer side effects to patients.
The most prominent surgical
robot is called da Vinci, manufactured by a company in Sunnyvale, California and
sold to hospitals at a cost of around $2 million apiece. Surgeons using the
minimally invasive, 3-D system operate through just a few small incisions, using
tiny wristed instruments that bend and rotate far more than the human
The device translates the surgeon’s hand movements into smaller,
more exact movements of tiny instruments inside the body. Da Vinci has so far
been used successfully around the world, including some Israeli medical centers,
in about 1.5 million operations.
The surgery is performed entirely by the
surgeon, who sits at a console in the operating room and views the procedure on
an enhanced, high-definition monitor. The surgeon uses joysticks that track
movements, which are then translated in real-time to the scaled movements of a
robotic device that enables the operation to take place. The ends of the robotic
arms are fitted with miniature surgical instruments that are capable of moving
in any direction. The EndoWrist instruments can be directed with extreme
accuracy and precision. The da Vinci system allows surgeons to operate for
longer periods of time with less fatigue and virtually no hand tremor.
provides delicate handling of the prostate tissue permitting extremely accurate
cutting of nerve tissue.
A prime user and innovator in the field of
robotic urological surgery – especially focusing on prostate cancer operations –
is Prof. David Samadi, chairman of the urology department at Lenox Hill Hospital
His department has two da Vincis – one used for
gynecological and general surgery and the other on urological
Only recently did he leave his post as vice-chairman of the
urology department and chief of robotics and minimally invasive surgery at the
Mount Sinai School of Medicine not far away.
Well known to the American
public, Samadi is a host of Sunday Housecall on the Fox News Channel with Dr.
Marc Siegel that is broadcast every Sunday morning.
“IT TAKES only one
hour to treat men with prostate cancer, followed by one night at the hospital
and one week connected to a urinary catheter – that’s all. It’s much shorter a
process than by conventional surgery,” Samadi told The Jerusalem Post
in a phone
interview from New York. He is due this week to visit Holon’s Wolfson Medical
Center to give lectures, meet with other doctors in the field and give
consultations to prostate cancer patients. About 70 to 100 Israelis a year make
the trip to his hospital in New York, as with some 5,000 prostate operations so
far, he has far more experience than his counterparts using the robotic
techniques here and even in much of the US.
His reason for leaving the
medical center on the Upper East Side of Manhattan to Lenox Hill just a short
distance southward, he said, was because prostate surgery was performed “on an
assembly line, with several surgeons entering and leaving operating theaters and
working on several patients simultaneously.”
At his new surgical home,
Samadi says, he stays with each patient from the beginning to the end. An entire
team of 25 people left Mount Sinai and came with him to Lenox Hill.
elegant hotel with private rooms is attached to the hospital “to make sure that
patients don’t feel they are sick. The next day, they are able to go
He is both a board-certified urologist and an oncologist
specializing in the diagnosis and treatment of urological diseases, prostate
cancer, kidney cancer and bladder cancer, his specialty of advanced minimally
invasive treatments for prostate cancer includes laparoscopic (“keyhole”)
radical prostatectomy (prostate gland removal) and laparoscopic robotic radical
SAMADI WAS born to a Jewish family in Iran. In 1979, at
the age of 16, he and his younger brother fled the country after the overthrow
of the Shah’s government. They grew up and were educated in the Persian Jewish
communities of Belgium and London.
Samadi completed high school in
Roslyn, New York, and then attended the State University of New York at Stony
Brook to earn his degree in biochemistry on a full scholarship.
completed his postgraduate training in general surgery at Montefiore Medical
Center and in urology at Yeshiva University’s Albert Einstein College of
Medicine and Montefiore Medical Center. He completed an oncology fellowship in
urology at Memorial Sloan Kettering Cancer Center and a robotic radical
prostatectomy fellowship at Henri Mondor Hospital Creteil in France under the
mentorship of Prof. Claude Abbou. Together with Abbou, Samadi performed the
first 11 da Vinci robotic prostate surgeries in the world.
Samadi doesn’t live here, he understands Hebrew and has a kosher home. “I have
come to Israel since I was a kid, and visited since about seven or eight times.
My father lived in Israel for 10 years, and my grandfather had a house in
He has a wife and two young children, aged 11 and eight. “At a
recent Israel Bonds dinner, I was keynote speaker and raised over $6 million for
Israel. I also received the Israel Peace Medal.”
Asked why he decided to
become a surgeon after receiving his medical degree, Samadi says he had always
observed his father, who was in the healthcare business and imported and
exported radiology equipment. “I spent a lot of time with him in the hospital. I
always thought the guys in green or blue pajamas – the surgeons – were the
coolest people in the hospitals.”
There are women surgeons, but besides a
few who do female urological operations, there are very few who perform prostate
removal on men, Samadi says. “I thought the prostate was a very interesting
organ.” A healthy human prostate is said to be a bit larger than a walnut. It
surrounds the urethra just below the urinary bladder, and its function is
secrete a slightly alkaline fluid that comprises half to 75% of the volume of
the semen along with spermatozoa and seminal vesicle fluid. “It is located in a
strategically difficult place, surrounded by sensitive nerves,” Samadi
THE NEW Yorker is one of the few urological surgeons in the US
to be trained in oncology, open, laparoscopic, and robotic surgery. He is also
the first surgeon in the United States to successfully perform a robotic surgery
“re-do,” a repeat procedure after patients suffered adhesions and other
complications that had to be repaired. So far, he has performed more da Vinci
operations on prostates than any other prostate cancer surgeon in all of New
Samadi developed a “unique” procedure that he calls SMART (Samadi
Modified Advanced Robotic Technique) surgical technique, which improves sexual
function as well as urinary control. He says he achieved this by “building on
oncological principles learned with open radical prostatectomy and transferring
them to a robotic approach – recreating the classic open anatomic technique as
closely as possible on the robotic platform.”
Samadi claims that with his
SMART technique, he is able to ensure continence in 97 percent and sexual
potency in 81% of his at one year after surgery.
At Lenox Hill, he has a
dedicated cancer surgery unit only for urological cancer patients – only one
operation at a time. “We care about quality,” he boasts, “not
Others who do robotic prostate surgery “peel the nerves off
the prostate gland like the skin from an orange. But I have reversed it take the
orange, leaving the skins intact. It remains like a hollow orange so as not to
endanger sexual potency and urinary control.”
Samadi gave lectures and
demonstrations in 2010 and performed a live SMART surgery robotic prostatectomy
at Rambam Medical Center in Haifa Sheba Medical Center at Tel Hashomer. He
invites Israeli surgeons to learn his technique from him at Lenox Hill and
maintains that he is willing to come to Israel once in several months to train
local surgeons in his techniques.
“Robotic surgery is only as good as the
person behind the device; behind any successful robot is an experienced surgeon.
It doesn’t work by itself,” he declares. “I’ve operated on three presidents of
countries and many celebrities in addition to many, many patients who are not,”
he says. “In the last seven years, none of my patients has needed a blood
transfusion; no one suffered rectal perforation.”
When asked about
Israel’s “most famous prostate cancer patient in recent years – former prime
minister Ehud Olmert – he says he did not operate on him; another surgeon from
Cornell University did it and does not elaborate.
“The technology is
always improving. Genetic testing has been added, because carrying a defective
BRCA gene that greatly increases the risk of breast cancer in women also
significantly raises the risk of prostate cancer in men. Today, there are men in
their early 40s who have aggressive prostate cancer.”
Unlike others who
claim that men have no need of getting screened for prostate-specific antigen
(PSA) when they get older because in many cases, men with the usually
slow-growing tumor will probably die of something else and surgery can do “more
harm than good,” Samadi disagrees. He recommends PSA screening. “A lot of men
are told, especially in Israel, that nothing should be done if they have ‘a
little cancer. But when we remove the prostate, we often find more cancer of an
aggressive type. So my message is to be very careful about watchful waiting. If
one can have the prostate removed without causing sexual dysfunction and
incontinence, they can put the problem behind them,” Samadi insists.
cases where patients need radiation, he recommends that it be performed after surgery.
“It’s almost impossible to do surgery after radiation, which
alone can cause rectal, bladder and other cancers and impotence.”
RECENTLY caused some controversy when he said on the Fox News show that women
should more for health insurance than men. “Women have the breasts, they have
the ovaries, they have the uterus; they get checked in every part…Look, it’s not
bias, I’m not saying this as a man,” he said. “They go through a lot of
preventive screenings, they give birth, they have the whole mammogram, the Pap
smear. Guys, we don’t like to go to doctors, right? Seventy percent of health
care decisions are made by women. In my own practice, I see it’s the women who
bring the guys, who say, ‘Go get screened.’ Otherwise, we would never
Asked about it, Samadi said he meant his statement in a positive way
– that men should act like women and be more concerned about their health and go
for health checks.” He also urges the many overweight and obese men in the US to
lose weight, as being too fat raises the risk of prostate cancer.