SMART Surgery Technique for Prostate Cancer in New York, NY
The SMART Surgery technique, short for Samadi Modified Advanced Robotic Technique, is Dr. David Samadi’s refined approach to robotic prostatectomy. Drawing on his fellowship training in both urologic oncology and laparoscopy, Dr. Samadi recreates the principles of classic open anatomic prostatectomy on the da Vinci robotic platform, using the robot’s magnified vision and precise instruments to remove the cancer while carefully protecting the structures responsible for continence and sexual function. At Prostate Cancer 911, it is the foundation of how we treat localized prostate cancer.
The Philosophy Behind SMART Surgery
Dr. Samadi does not view the robot as a cure in itself. Instead, he sees it as a tool that allows a highly experienced surgeon to perform a more precise anatomic prostatectomy than is possible with open or straight laparoscopic instruments. The robotic platform offers a high-definition, three-dimensional view magnified many times over, along with wristed instruments that reach angles the human hand cannot. Combined with experience from more than 10,000 robotic prostate surgeries, this precision allows Dr. Samadi to work closer to the prostate and avoid unnecessary damage to surrounding nerves and muscles.
SMART Surgery is an advanced technique that requires extensive robotic experience. It was refined over years of practice, with final modifications made in 2008, and can be performed with a mean operative time of under two hours.
The Prostate Cancer Treatment Trifecta
SMART Surgery is built around three goals that matter most to men facing prostate cancer:
- Total cancer removal
- Preservation of sexual potency
- Preservation of urinary continence
In this video, Dr. Samadi explains the principles of SMART Surgery and the benefits it provides.
The 8 Key Steps of SMART Surgery
Step 1: Dropping the Bladder
The bladder is gently released from the abdominal wall to expose the prostate. Fat on the front of the prostate is removed and sent for pathology, since it occasionally contains lymph nodes that provide important staging information.
Step 2: Bladder Neck Transection
The bladder is carefully separated from the prostate while preserving as much of the bladder neck as possible, which supports earlier return of continence.
Step 3: Seminal Vesicle and Vas Deferens Dissection
The seminal vesicles and vas deferens are freed and lifted, giving clear access to the back of the prostate.
Step 4: Posterior Dissection
The prostate is separated from the rectum in the proper surgical plane, protecting the rectum and preparing for nerve sparing.
Step 5: Nerve Sparing
The neurovascular bundles that control erections run along the sides of the prostate. In SMART Surgery, these delicate nerves are released with minimal use of heat energy and minimal traction to protect sexual function whenever the cancer allows.
Step 6: Dorsal Venous Complex and Apical Dissection
The veins over the prostate are controlled and the apex of the prostate is precisely divided from the urethra, preserving maximal urethral length and the urinary sphincter for better continence.
Step 7: Prostate Removal and Lymph Node Dissection
The prostate is placed in a bag and removed through a small incision. When indicated by risk level, pelvic lymph nodes are removed for staging.
Step 8: Urethrovesical Anastomosis
The bladder is reconnected to the urethra with a running, watertight stitch, allowing a catheter to be removed sooner and supporting a smooth recovery.
Benefits of SMART Surgery
- Small incisions with less blood loss and pain than open surgery
- Short hospital stay and faster return to normal activity
- Precise nerve sparing to protect erectile function
- Sphincter and bladder neck preservation to support continence
- Complete pathology staging of the removed prostate
Is SMART Surgery Right for You?
SMART Surgery is most often recommended for men with cancer confined to the prostate who are healthy enough for surgery. Learn more about SMART Surgery for prostate cancer treatment, the prostate cancer treatment trifecta, and your prostate cancer treatment options, or call Prostate Cancer 911 at (212) 365-5000 to schedule a consultation.
Related Care and Resources at Prostate Cancer 911
SMART Surgery FAQs
What does SMART stand for?
SMART stands for Samadi Modified Advanced Robotic Technique, a robotic prostatectomy approach developed by Dr. David Samadi.
How is SMART Surgery different from standard robotic prostatectomy?
SMART Surgery recreates the principles of open anatomic prostatectomy on the robotic platform, with refined steps for nerve sparing, sphincter preservation, and bladder reconnection designed to improve cancer control, continence, and sexual function.
How long does SMART Surgery take?
The procedure can be performed with a mean operative time of under two hours.
Will I keep my sexual function after SMART Surgery?
Nerve-sparing techniques are designed to protect erectile function whenever the cancer allows. Recovery varies and can take months, and treatments are available to help along the way.
How soon will I regain bladder control?
Most men regain continence over weeks to months. Preserving the bladder neck and urinary sphincter supports earlier recovery. Learn more about continence after surgery.
Who is a candidate for SMART Surgery?
Men with prostate cancer confined to the gland who are healthy enough for surgery are typically good candidates. Dr. Samadi reviews each case individually.
How do I schedule a SMART Surgery consultation?
Call (212) 365-5000 or request an appointment with Dr. Samadi.
Schedule Your Consultation With NYC’s Leading Urologist
Take control of your health today. Whether you are seeking a second opinion or experiencing symptoms like hematuria, Dr. David Samadi and the team at Prostate Cancer 911 are here to provide world-class care in Midtown Manhattan.
Request an AppointmentOffice Location: 485 Madison Ave, 21st Floor, New York, NY 10022
Phone: (212) 365-5000