From the Wires
Robotic Prostatectomy Expert Dr. David Samadi, MD Stresses the Importance of a Surgeon's Experience in Robotic Surgery
By: Marketwired .
Jan. 12, 2010 01:10 PM
NEW YORK, NY -- (Marketwire) -- 01/12/10 -- In a recent study, the Memorial Sloan-Kettering Cancer Center discovered that inexperienced surgeons treat many American prostate cancer patients. This lack of high-volume experience (a caseload of at least 50 procedures a year) leads to increased complications such as incontinence and impotence, and possible cancer recurrence. Dr. David Samadi, Chief of the Division of Robotics and Minimally Invasive Surgery in the Department of Urology at The Mount Sinai Medical Center in New York, a vocal proponent of extensive surgical experience, responded, "Practice makes perfect, especially when it comes to surgery."
The 2005 study focused on radical prostatectomy (removal of the prostate gland), performed laparoscopically, traditionally and with robotics. The results were that more than a quarter of the 933 doctors studied had performed just one surgery that year. Moreover, 80 percent of the surgeons performed 10 or fewer procedures. Previously, it had been determined by researchers at Memorial Sloan-Kettering that an experienced surgeon needed to perform about 250 radical prostatectomies for the best outcomes. The study concluded that many of the surgeons would not be able to achieve that number of procedures in their entire career.
According to the research, only two percent of surgeons in the country, and four percent in New York, could be considered high-volume surgeons. Due to large, specialized cancer treatment centers, New York has the largest concentration of high-volume prostate cancer surgeons, including Dr. Samadi, who has performed over 2,100 successful procedures in his Manhattan practice. An oncologist trained in open, laparoscopic and robotic surgery, Samadi feels that the broad training is what gives him his enhanced expertise in robotics. "After all, it's not the robot that does the surgery; it's the surgeon," he emphasizes.
It is important to note that the study only involves American surgeons, saying nothing the regulations and experience of surgeons practicing overseas. In the U.S., however, the FDA currently mandates that surgeons take a weekend course to learn how to use a robot for prostate surgery, and then be monitored by a surgeon who has done at least 20 cases. But Dr. Samadi has long believed that the learning curve for robotics is too steep to be learned in just one weekend of training. According to Dr. Samadi, it takes a caseload of at least several hundred to become proficient at operating with the da Vinci surgery robot.
However, learning time is a commodity, particularly when in 2003, the Accreditation Council for Graduate Medical Education imposed a national limit of 80 hours a week for all medical trainees. These limitations unfortunately restrict a surgeon's experience. The time limit, devised to ensure well-rested doctors, greatly affects patient care and surgical outcomes, as was noted in a recent analysis article, appearing in the British Medical Journal (BMJ). Written by doctors from Vanderbilt Children's Hospital in Nashville, Tennessee, the authors concluded that these regulations needed to become more flexible for the sake of patients. Flexibility in training hours is vital to attain needed experience and ample exposure to cases. The question remains how to balance these regulations with the experience needed for successful surgical outcomes.
The moral to the story, says Dr. Samadi, is experience goes a long way when it comes to prostate cancer surgery. For a better cure rate and reduced incidence of complications, "do your homework," says Samadi. "Go with a high-volume, multi-disciplined surgeon that operates with a skilled team in a center of excellence."
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