By David Samadi MD & Marc Siegel MD
A man who is about to have his cancerous prostate removed is a man focused on one extremely important question. Will he ever be able to have sex again?
You might think that the answer is one of statistics, of finite probabilities, of precise science. But it isn’t.
The answer is as much about the art of medicine as it is about the science. The answer is about who performs the surgery, what technique they use, and how experienced they are in doing it. What is the exact surgical approach and what results have they had? For all the discussion recently about one treatment or surgery being more cost effective than another, when it comes to the prostate the reality for a man is not about cost at all, it’s about that ability to achieve an erection.
It is undeniable that the da Vinci robot (where the surgeon sits at a computer and operates robot arms) enables him to expose the prostate with a smaller incision, to remove it with little or no blood loss. But operating a fine instrument like the da Vinci is like driving a Lamborghini, unless you know what you are doing, you might be better off with a simpler machine.
When it comes to enabling a man to retain or recover the ability to have sex, the main problem is that the prostate is encased in nerves that stimulate the penis to become erect. Previous nerve-sparing techniques were revolutionary in their time, and they were sometimes successful, but it is literally like waving a knife in the dark and hoping to avoid nicking a crucial nerve with it. Even the most experienced surgeon is not always successful.
The SMART technique, Samadi Modified Advanced Robotic Technique, offers an advantage that has led to a very high success rate at male potency. SMART’s goal is to take the prostate from the nerves rather than trying to dissect the nerves from the prostate.
Coupled with penile rehabilitation, in the right hands this technique has made thousands of men happy. Dr. Samadi has performed it on over 4,000 patients and has seen it work successfully time and again. The prostate and its nerves are surrounded by tough fibers known as fascia. By approaching the prostate from behind, via the rectum, a surgeon may avoid these fibers and the nerves altogether.
Rather than doing his best to minimize a problem, driving his scalpel through a virtual forest of nerves, instead a surgeon may avoid them altogether. A surgeon using SMART also does not cut the main vein of the penis which helps to preserve the blood flow needed for erections.
But even more than the technique, it is the experience that counts. SMART can be taught to other prostate surgeons who then can perform it on their patients. The art of medicine is not something you learn from a textbook; it is transmitted from doctor to doctor almost as a transfusion of learning.
We believe in statistics and an analytic approach to medicine. But when it comes to the jewel of the prostate, buried deep in a man’s body, it is a profound art to remove it successfully without damaging a man’s essential nature. Simple studies that try to compare one technique to another can’t possibly take into account the art.
For that you need more than statistics alone, you need old-fashioned know-how and the right creative approach.
David Samadi MD is vice chair of urology and chief of robotics at Mt. Sinai Medical Center. Marc Siegel MD is professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center.News