Top Doctor: Robotic Surgery’s Bad Rap

   March 18, 2014   

By Nick Tate, NewsMax

Robotic prostate surgery has been called one of the greatest advances in the war on cancer and many experts believe it is the wave of the future in medicine. By using computer-guided instruments, surgeons can be more precise in the operating room, leading to fewer complications and better cure rates for patients, particularly those with aggressive tumors.
In recent months, however, questions have been raised about robotic surgery and the Food and Drug Administration is looking into reported problems with some doctors using the technique.
But a leading authority in the field tells Newsmax Health that robotic prostate surgery is not only safe, but the technique offers a dramatic improvement over conventional procedures. Dr. David Samadi, chairman of Urology and Chief of Robotic Surgery at Lenox Hill Hospital in New York City, says the key is making sure your surgeon is well-trained and experienced in using the new technology to maximize its benefits.
In fact, Dr. Samadi welcomes the new FDA scrutiny, which he hopes will help weed out incompetent and inexperienced “bad apple” surgeons who are using the technique with minimal training.
“I’m glad that they’re looking into this because I think that we have a lot of surgeons that may be taking a weekend course and come back on Monday and pretend that they are robotic surgeons,” he says. “I always say that if you have a skilled surgeon plus the technology of robotics [then] you would end up with good outcome[s].
“If you have someone who is not well trained, plus technology, that’s quite dangerous and you end up having a lot of complications. So when patients look for … robotic surgeons, you want to choose the skilled and experienced surgeon — that’s really the key message out there.”
Another problem, Dr. Samadi notes, is that in some hospitals, prostate surgeons only perform parts of the operations and leave technicians to handle key aspects of the procedure.
“I really think that that’s bad medicine,” he says. “The surgeon should be committed to the patient and perform the entire case from the beginning to the end, and that’s what’s going on at Lenox Hill.”
Dr. Samadi, who has performed more than 4,000 robotic procedures, notes a doctor’s experience — in traditional “open” surgery, laparoscopic skills, and oncology — is not only important when it comes to using the computer-assisted machines, but is also critical in the event something goes wrong in the OR.
“What if the robotic [technology] breaks during the operation?” he says. “Are you as my doctor trained in laparoscopic surgery or can you convert to open [surgery]? You have to have the experience before you sit behind one of these fancy robots and be able to … use the robot as an extension of [your] arms.”
In experienced hands, robotic surgery has a better cure rate and fewer complications, compared to conventional open surgery, studies have shown. That’s because the computer-assisted technology allows doctors to be more precise in removing the prostate gland, while sparing surrounding nerves and other tissues that, when cut or damaged, can lead to impotence, incontinence, and other complications. That, in turn, reduces the risk for follow-up treatments, such as radiation, chemotherapy, or hormone treatments.
In fact, a new observational study out this month by the University of California-Los Angeles found that prostate cancer patients who undergo robotic-assisted prostate surgery have fewer cancer cells at the edge of their surgery sites, less need for additional treatments, and fewer complications than patients who have open surgery.
Dr. Samadi says his own experience supports these conclusions.
“Right now with urinary control, about 95 to 97 percent of the patients are continent and … with [robotic] surgery, the patients recover and they do better,” he explains, adding that only 20 percent of his patients experience some sexual dysfunction after surgery. “We also have a lot of medications — such as Viagra, Levitra, Cialis — that we use in our practice to be able to make the recovery with sexual function much easier for them.”
He also believes an experienced doctor is in the best position to advise patients about their treatment options and determine who is most likely to benefit from surgery. He notes, for instance, that the recent controversy over the PSA test has left many men uncertain about whether to have the cancer screening — a decision that can be informed by experienced prostate cancer specialist.
The U.S. Preventive Services Task Force recommends against routine prostate specific antigen (PSA) cancer screenings for most men, citing evidence that the risks of screening outweigh the benefits.
But new research out this month, led by Memorial Sloan Kettering Cancer Center, found that areas where PSA screening is performed more frequently have lower death rates from prostate cancer than those where there is little testing. That research, published in the Journal of the National Cancer Institute, contradicts the findings of past studies that have raised questions about the benefits of PSA screening and undercut the recent federal guidelines that recommend against routine testing.
Dr. Samadi notes the PSA test is not perfect and that an elevated PSA is not only a red flag for cancer, but also enlarged prostate, inflammation, and infection. But he still advocates its use, over time, to track levels as they rise or fall — a trend line that can help a doctor identify those patients who should be more aggressively treated and those who should simply be monitored for signs of a life-threatening cancer.
“That’s why the skill of the doctor, and … the art of medicine, [is important] to distinguish when to do the biopsy … and who you’re going to watch and who you’re going to do the surgery [on],” he says.
The bottom line?
“There is life after prostate cancer, there is good continence and sexual function,” he says. “You just have to choose the right doctor.”
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