Doctor Discusses Plans To Perform Tele-Surgery
Lunch at the Four Seasons
By PRANAY GUPTE - Special to the Sun
January 17, 2006
He was a Jew in Islamic Iran and only 16 when his parents decided that David Samadi and his younger brother, Daniel, should leave their homeland, which was being riven by a conflict with neighboring Iraq.
"My brother and I took a midnight flight out of Tehran to Brussels," said the director of robotic laparoscopic surgery at Columbia Presbyterian Medical Center in New York City. "We had no idea what lay ahead. We had no idea when our parents and sister would join us - or even if we would see them again."
It would be another eight years before the Samadi brothers were to be reunited with their parents and sister, Hedieh, who was only 6 years old when her brothers left.
Those years were partly spent in Belgium under the tutelage of family friends, David Ekstein and Amos Nissim, who were jewelers. The Samadi brothers then moved to London for high school.
But Britain did not prove especially hospitable. For one, the boys were far more fluent in their native Farsi and in French - which is widely used in Iran - than in English. They were also uncomfortable with British customs and tradition, finding them fusty.
They completed high school in the Long Island town of Roslyn, where their parents also had friends. Meanwhile, what was once a 150,000-strong community of Jews under the Shah of Iran had dwindled to less than 40,000, as ayatollahs consolidated the theocracy that had overthrown the monarchy.
That was when Mr. Samadi, by now at the State University of New York at Stony Brook, urged his parents and sister to come to America
"Our parents had been anxiously following our lives - like a cardiologist examining an EKG - all the spikes and dips, all the ups and downs," he said. "I called them and said, 'America - this is the place to be!'"
It was indeed the place to be for an ambitious young emigre who wanted to become a physician. Invited to join a special program called "Scholars of Medicine," Mr. Samadi raced through Stony Brook and finished his medical training. His brother, who went to New York University as an undergraduate, obtained a medical degree from Johns Hopkins Medical School in Baltimore.
Dr. Samadi was initially interested in cardiothoracic surgery, but a chance encounter with Dr. Arnold Melman, a celebrated urologist at Montefiore Medical Center, led to a switch.
"I began to specialize in uro-oncology - prostate cancer," Dr. Samadi said.
It was a propitious time for a young physician to pursue that specialty. Prostate cancer, which is diagnosed in 220,000 men in America each year, had emerged as the second-leading cause of cancer-related death in men, claiming more than 40,000 victims annually. Health care costs were soaring, and the cost of hospitalization and treatment were becoming prohibitive. (Typical prostate surgeries can cost between $5,000 and $10,000.)
"It was also a time when there were significant advances in medical science," Dr. Samadi said. "I was there at the right time."
He was there when three new words were injected into the medical lexicon: robotic laparoscopic prostatectomy. Dr. Samadi had already gained some repute in the more conventional type of prostate surgeries, including the open form, where an 8- to 10-inch incision is made to remove a 2-inch organ, which causes enough blood loss that about 20% of patients require a blood transfusion.
He had also become fluent in laparoscopic surgery, which involves just five small "keyhole" incisions in the patient's abdomen, through which extremely fine instruments are inserted, along with a miniscule camera that displays on a screen magnified two-dimensional images from inside the body.
It was his mastery of robotic laparoscopic prostatectomy that brought fame to Dr. Samadi - not the least because he was one of only three or four physicians in the New York area who performed such surgeries.
That mastery was gained through two related fellowships: one in oncology at Memorial Sloan Kettering Cancer Center in New York, and the second in laparoscopy at Henri Mondor Hospital in Creteil, France. His mentor in France over a nine-month period was Dr. Claude Abbou, one of the pioneers in laparoscopic prostate surgery.
Dr. Abbou taught Dr. Samadi how the addition of a sophisticated robotic control system - called the da Vinci - transforms two-dimensional images into three dimensions and enables the surgeon's hand movements to be scaled, filtered, and translated into precise movements of the surgical instruments.
"The result is greater precision in both cutting and suturing, less trauma to surrounding tissue, and minimal blood loss," Dr. Samadi said. "Instead of two to three days of hospitalization and two months of recuperation typical with open prostate surgery, laparoscopic surgery patients often go home the next day and are back to normal activities within two weeks.
"Perhaps most encouraging of all, early data on prostate surgery performed via robotic-assisted laparoscopy with the da Vinci indicate that patients have a better chance of continence and potency after the procedure than with traditional open surgery," he said.
Dr. Samadi soon plans to perform tele-surgery on patients abroad. His experiences will go into a book that he hopes to write.
"This technology was intended to ultimately enable a doctor to perform long-distance surgeries," he said. "But robotic technology has advanced so rapidly that we're now able to perform the surgeries without delay."
Dr. Samadi smiled.
"But it's not the robot that makes you a good surgeon," he said. "The learning curve for robotic laparoscopy is so great that a surgeon must perform at least 60 to 100 procedures before reaching a true level of competence."
Dr. Samadi has performed more than 350 robotic surgeries. Last Friday, he removed a prostate that weighed 204 grams; a normal prostate gland weighs about 30 grams.
He has reassuring words for men who worry about sexual dysfunction after prostate surgery.
"Robotic surgery makes such dysfunction less and less likely," said Dr. Samadi, who is married to a fellow Iranian, Sahar, and has two young children, Jasmine and Alex.
Dr. Samadi advises men older than 40 to get an annual prostate screening, which includes digital examination and prostatic specific antigen blood tests.
"If detected early, the cancer cure rate is superb," Dr. Samadi said. "I know how terrified men feel once they are hit with news that they have prostate cancer. I'm not just a doctor. I always try to reach out and touch their heart. I carry patients and their families through the journey of hardship toward cure. After all, I've been on such a journey myself when I left Iran."
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