SMART Surgery for Prostate Cancer Treatment

How is Dr. Samadi’s SMART robotic prostate surgery unique?

The Samadi Modified Advanced Robotic Technique (SMART) is a minimally invasive robotic-assisted laparoscopic prostatectomy (RALP). After fellowship training in urologic oncology and laparoscopy, and many years of robotic prostate surgery experience, David B. Samadi, MD, developed his own surgical modifications that are distinct to SMART. This custom procedure is an advanced application of robotic technology for the removal of cancerous prostates.

Dr. Samadi performs every SMART surgery himself from start-to-finish, with three measures of success:

  1. Total removal of prostate cancer cells
  2. Sex after prostate cancer
  3. Urinary control after prostate surgery

 Prostate cancer surgeon - Dr. Samadi

Unlike traditional prostate removal surgery that approaches the prostate from the outside in, SMART surgery enters the prostate from the inside out. Without cutting or damaging three critical areas, Dr. Samadi optimizes post-surgery sexual function and urinary continence.

Preservation of the endopelvic fascia, the urinary sphincter, and the surrounding neurovascular bundles, plus a unique treatment of the dorsal vein complex, are the cornerstones of SMART success. Each modification allows Dr. Samadi to remove the walnut-sized prostate with minimal disruption to the surrounding area.

Further, the dorsal vein complex is left unstitched until the end of the procedure, allowing Dr. Samadi to control the length of the urethra and minimize leaking after surgery. Tiny nerve bundles are further protected by the use of cold scissors and clips, never cautery, during surgery.

Learn more about David B. Samadi, MD’s SMART surgery procedure.


SMART Surgery vs. traditional prostate surgery techniques

In the beginning, open surgery techniques offered men with advanced prostate cancer a second life. Since then, the world of technology enhanced these techniques to the point where patients no longer feel a before and after surgery. Patients that opted for SMART surgery are resuming their lives with better continence, better sexual function, and no major surgery complications. Here’s why.

Key SMART robotic surgery aspects:

  • Minimally invasive (surgeons only need to introduce small-sized surgical instruments while a robotic camera assists them with a clear field of view);
  • Faster recovery;
  • Reduced blood loss;
  • Blood transfusion rate nears 0.


Key traditional prostate surgery aspects:

  • Open radical prostatectomy (surgeons need to cut the skin and tissue in order to have a clear field of view and manipulate surgical instruments by hand;
  • Longer frame of time to wear a catheter;
  • Blood transfusion rate is anything between 8% to 40%.

What are the advantages of SMART surgery for prostate cancer?

Minimally invasive SMART surgery helps patients recover from prostate cancer and surgery faster and with fewer complications than other techniques. 

With proper adherence to post-surgery guidelines, Dr. Samadi and SMART surgery deliver:

  • 89% of cancer-free patients, with less than 2% seeing a recurrence of cancer 1 year after surgery;
  • Urinary continence within 12-13 months of surgery among patients who experienced normal continence prior to surgery;
  • Sexual potency is at 96.6% after 18 months from radical prostatectomy, with higher potency rates for younger men, according to studies.

One of the greatest benefits of SMART surgery is the lifelong zero PSA level enjoyed by most men. The peace of mind afforded by the complete removal of the cancerous prostate is invaluable to Dr. Samadi’s patients and their families.

How long does SMART surgery take?

Dr. Samadi performs SMART surgery in less than 90 minutes, thereby reducing the patient’s exposure to risk and blood loss. Most patients return home the day after their surgery.

Once patients wake up after SMART surgery, the only visible difference they notice consists of six tiny holes in the abdomen. 

What are the reduced risks with SMART robotic surgery?

By leveraging robotic technology, individuals who choose SMART surgery as their primary treatment for prostate cancer are increasing their chances of a better quality of life after the procedure. That’s because the SMART surgery technique doesn’t resort to sutures so nerve damage is kept to a minimum. Furthermore, there are great chances that the SMART surgery is not going to affect nearby tissues. 

Therefore, it’s only natural that the SMART robotic surgery achieved the following:

  • 97% of the patients are continent;
  • 85% of the patients are sexually active;
  • On average, a patient can return to normal activities within 6 weeks after surgery.

What is robotic assisted prostatectomy?

Robotic assisted prostatectomy is a surgical procedure that is performed to remove the prostate gland affected by cancer.

The three types of robotic assisted prostatectomy are:

– Robotic simple prostatectomy: it usually takes 2 to 3 hours and is recommended to treat extreme prostate enlargement with extenuating circumstances. In the case of robotic simple prostatectomy, the number of improvements over open surgery is minimal. There’s still less pain, less blood loss, and better visualization.

– da Vinci robotic prostatectomy: either through a few small incisions or one cut, the da Vinci method moves surgeons away from the patient. Instead, surgeons sit at a console from where they control tiny instruments found at the end of robotic arms.

– Robotic laparoscopic prostatectomy: during this technique, surgeons employ special long-handheld tools and they get their field of view through a camera called laparoscope that displays the imaging on a video screen in real time

What happens during robotic prostate surgery?

During robotic prostate surgery, patients remain under anesthesia at all times.  Once placed in a lithotomy position, the patient is ready for operation.

The surgeon is going to perform six small incisions along the lower abdomen. Through these holes, a series of instruments are going to penetrate the body all the way to the prostate gland. One of them is a camera or laparoscope that allows the surgeon to see inside the body on a magnified scale.

All instruments are operated by a computer-assisted mechanical device that moves these tools only at the command of the surgeon. The surgeon operates this computer from a console and has clear sight of all the delicate nerves and tissues that surround the prostate gland, which helps the specialist to preserve those structures that don’t require any intervention during prostatectomy. 

After dissecting the prostate gland with robotic precision, the surgeon is going to eventually remove it through one of the six incisions. At no point during the procedure is the hand of the surgeon needed inside the patient’s body. The entirety of the operation is carried out by robotic arms, and that contributes to a minimally invasive procedure that renders less blood loss, less pain, shorter hospital stays, and faster recovery times.

What is unique about Dr. Samadi’s SMART surgery?

Beyond surgical techniques and prostate cancer outcomes, Dr. Samadi is highly involved in the emotional well-being of each patient, and that of their partner and family.

When stepping into his office you become a member of his team and the level of care you receive reflects that dedication. This is done in a number of ways, before, during, and even after surgery – it’s a bond that never ends.

Many doctors and surgeons focus only on physical health, but fail to address each patient’s needs as an individual; a person who has questions and fears and needs answers and support. Dr. Samadi and his staff provide this one-on-one care throughout a patient’s whole treatment process.

When it comes to the surgical process, Dr. Samadi handles things in a way very few doctors can claim. It’s very typical for a surgeon to perform just the major parts of the robotic prostate removal operation, opting to have a surgical team perform the minor aspects that require less technical skill and know-how. This is the antithesis of personal care; a doctor who shows up, does a job, and leaves for the next operating room.

In each case, Dr. Samadi performs the entire procedure from the beginning to the end. His surgical team does assist, but at no point are they left to perform surgery. When dealing with something as serious as prostate cancer, this is critical.

What can I expect during recovery from SMART surgery?

After the procedure, Dr. Samadi will meet you in the recovery room to answer any remaining questions about follow-up care. Patients typically return home the day after surgery. A catheter will be in place; however, only for seven days. In contrast, open prostate removal surgery requires a catheter for several weeks post-op. The catheter is removed during a simple, in-office procedure.

Often men return to work just 2-3 weeks after surgery, and by 4-6 weeks most are comfortable resuming normal activities.