Da Vinci Robotic Prostatectomy

Step-by-Step Robotic Prostatectomy: Surgical Techniques and Highlights

Understanding the intricacies of a robotic-assisted radical prostatectomy is essential for patients researching treatment options. In the following videos, Dr. David Samadi, a leading robotic surgeon in New York City, demonstrates the precision of the da Vinci Surgical System. These surgical highlights illustrate how advanced technology and expert technique work together to prioritize cancer removal while preserving quality of life.

Accessing the Prostate Gland and Bladder Mobilization

Dr. Samadi demonstrates the critical first steps of robotic prostate surgery: mobilizing the bladder to gain clear access to the prostate. This video highlights the da Vinci robotic instruments performing the “defatting” of the endopelvic fascia. This delicate work occurs beneath the pubic bone—an area notoriously difficult to visualize during traditional open surgery, but easily managed with robotic magnification.
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Bladder Neck Dissection Strategy

In this segment, Dr. Samadi explains his specialized technique of opening the bladder neck early during the prostatectomy procedure. By utilizing the fourth arm of the latest da Vinci robot, he maintains a safe distance from lateral tissues. This precise dissection is vital for separating the cancerous prostate from the bladder, ensuring a clean removal with minimal trauma.
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Managing the Vas Deferens and Seminal Vesicles

Precision is key when handling the vas deferens and seminal vesicles. Dr. Samadi utilizes surgical clips and relies on high-definition visual feedback to prevent tearing these delicate structures. With over 7,000 surgeries performed, Dr. Samadi discusses how an experienced surgeon gains a refined sense of “tactile feedback” through the robotic interface to improve patient outcomes.
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Dennonvilliers’ Fascia and Posterior Access

This video focuses on Dennonvilliers’ fascia, the posterior layer of the prostate. Dr. Samadi explains why the increased range of motion provided by robotic technology is the future of urology. This maneuverability allows for superior nerve-sparing techniques, which are essential for protecting the patient’s post-surgical function.
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Neurovascular Bundle Preservation for Sexual Function

Nerve-sparing robotic surgery is one of Dr. Samadi’s primary areas of expertise. By carefully preserving the neurovascular bundles at the base of the prostate, he helps patients maintain sexual function after cancer removal. This video also highlights the minimal blood loss associated with the robotic approach compared to open abdominal surgery.
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Pre-Operative Planning: Endorectal MRI and Nerve Harvesting

For patients with high-risk prostate cancer, comprehensive planning is required. Dr. Samadi discusses the importance of a pre-operative endorectal MRI to map the tumor accurately. He also explains sural nerve harvesting—a specialized procedure used to restore function in advanced cases where the original nerves cannot be spared.
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Minimally Invasive Neurovascular Bundle Protection

Observe the neurovascular bundle during a live prostatectomy operation. Dr. Samadi emphasizes that the less these nerves are manipulated, the higher the likelihood that the patient will retain full sexual potency. The “touch-free” precision of the da Vinci system is a major advantage in minimally invasive urology.
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Posterior Bladder Neck Reconstruction and Continence

Regaining urinary continence is a top priority for men after prostate removal. Dr. Samadi demonstrates his technique for posterior bladder neck reconstruction. By leaving a long urethral stump and meticulously reconstructing the area with the robotic system, he helps ensure a faster return to normal bladder control.
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Urethrovesical Anastomosis: Reconnecting the System

In the final stages of the robotic prostatectomy, Dr. Samadi demonstrates the urethrovesical anastomosis—the reconnection of the bladder to the urethra. He utilizes a specialized method involving a single suture and a curved needle to create a secure, water-tight seal, ensuring proper healing and long-term success.
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