S160: The application of intraoperative frozen section of the prostate to reduces positive margin rates while ensuring nerve-sparing procedure during robotic assisted radical prostatectomy – Initial UK single centre experience

147 Background: In robotic-assisted radical prostatectomy (RARP) intraoperative frozen sections are often avoided due to suspected difficulties in harvesting the prostate during this procedure, loss in pneumoperitoneum, increased blood loss and lacking impact on functional outcome. We demonstrate the technique, feasibility and beneficial impact of our NeuroSAFE technique on the rate of nerve-sparing (NS) in RARP and analyse the oncological outcome. Methods: We analyzed 1,570 consecutive patients undergoing RARP from 2004 to 2012. NeuroSAFE was done in 1,178 pts. We compared OR-time, blood loss, frequency of nerve-sparing (NS) and PSM in non-NeuroSAFE versus NeuroSAFE-RARP. The prostate was intraoperatively harvested via an extension of the camera trocar incision without undocking the system. Instrument arms were not undocked. Blood spillage from the dorsal vein complex due to loss of pneumoperitoneum was avoided by upward traction on the transurethral catheter. After prostate removal, pneumoperitoneum was reestablished by closing the extended incision and repositioning of the optical trocar. NeuroSAFE-procedure consisted of intraoperative bilateral frozen sections covering the entire contact area of the prostate and the neurovascular bundles. Results: There was no significant difference in blood loss (253.5±204.4 ml vs. 265.8±246.7 ml, p=0.49) and OR-time. (220 min ± 51 vs. 224 min ± 64, p=0.22). No complications associated with specimen harvesting occurred. NS-rate increased significantly with vs. without NeuroSAFE (overall 97% vs. 81%, pT2 99% vs. 90%, pT3a 94% vs. 74%, pT3b 91% vs. 30). PSM rate dropped significantly with NeuroSAFE (overall 16% vs. 24%, pT2 8% vs. 15%, pT3a 22% vs. 39%, pT3b 49% vs. 67%, all p<0.05). Conclusions: We demonstrate a time-efficient adaption of the NeuroSAFE without patient side cart undocking, easy harvesting process, no increased blood loss or OR-time increased rate of nerve-sparing frequency and reduction of PSMs.

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188 Intra-operative frozen section analysis to increase the rate of nerve-sparing procedures without compromising cancer control: Results from a contemporary population of patients treated with robotic assisted radical prostatectomy

European Urology Supplements ◽

10.1016/s1569-9056(15)60190-7 ◽

2015 ◽

Vol 14 (2) ◽

pp. e188

Author(s):

P. Dell'Oglio ◽

G. Lughezzani ◽

N. Suardi ◽

G. Lista ◽

N. Fossati ◽

...

Keyword(s):

Radical Prostatectomy ◽

Frozen Section ◽

Cancer Control ◽

Nerve Sparing ◽

Robotic Assisted ◽

Frozen Section Analysis ◽

Robotic Assisted Radical Prostatectomy ◽

Section Analysis

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PE28: Intraoperative frozen section of the prostate to reduce the risk of positive margin whilst ensuring nerve sparing in patients with intermediate and high-risk prostate cancer during robotic radical prostatectomy – first UK centre experience

European Urology Supplements ◽

10.1016/s1569-9056(14)50219-9 ◽

2014 ◽

Vol 13 (3) ◽

pp. 26

Author(s):

N. Vasdev ◽

A. Soosainathan ◽

T. Kanzara ◽

T. Lane ◽

G. Boustead ◽

...

Keyword(s):

Prostate Cancer ◽

High Risk ◽

Radical Prostatectomy ◽

Frozen Section ◽

Positive Margin ◽

Nerve Sparing ◽

Robotic Radical Prostatectomy ◽

Intraoperative Frozen Section ◽

High Risk Prostate Cancer ◽

Risk Prostate Cancer

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Intraoperative Frozen Section of the Prostate Decreases Positive Margin Rate While Ensuring Nerve Sparing Procedure During Radical Prostatectomy

The Journal of Urology ◽

10.1016/j.juro.2013.02.011 ◽

2013 ◽

Vol 190 (2) ◽

pp. 515-520 ◽

Cited By ~ 32

Author(s):

Christian von Bodman ◽

Marko Brock ◽

Florian Roghmann ◽

Anne Byers ◽

Björn Löppenberg ◽

...

Keyword(s):

Radical Prostatectomy ◽

Frozen Section ◽

Positive Margin ◽

Nerve Sparing ◽

Intraoperative Frozen Section ◽

Positive Margin Rate

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Effect of transperineal template prostate biopsy on perioperative and functional outcomes following robotic-assisted radical prostatectomy

Journal of Clinical Urology ◽

10.1177/20514158211002704 ◽

2021 ◽

pp. 205141582110027

Author(s):

Henry H Yao ◽

Kathryn Ball ◽

Alvaro Bazo ◽

Timothy R Terry ◽

Thomas J Walton

Keyword(s):

Radical Prostatectomy ◽

Functional Outcomes ◽

Operative Time ◽

Univariate Analysis ◽

Positive Margin ◽

Nerve Sparing ◽

Level Of Evidence ◽

Robotic Assisted ◽

Estimated Blood Loss ◽

Robotic Assisted Radical Prostatectomy

Objective: This study aimed to determine the effect of template transperineal (TTP) compared to transrectal (TR) biopsy on surgical and functional outcomes after robotic-assisted radical prostatectomy (RARP). Methods: From 2014 to 2018, 280 patients underwent RARP by a single surgeon. Of these, 184 had TR, and 96 had TTP biopsy. Primary outcomes were continence and erectile function recovery (EFR) rates up to 24 months postoperatively. Secondary outcomes comprised positive margin rates and markers of a difficult operation, including operative time, estimated blood loss (EBL), urethral preservation quality and ability to perform planned nerve-sparing surgery. Results: The median age was greater in the TTP group (64 vs. 62 years, p=0.028). The proportions of men with preoperative erectile dysfunction and men undergoing nerve-sparing surgery were not different between groups. Operative time, EBL, urethral preservation quality, proportion of men undergoing intended nerve-sparing procedure, positive margin rates and continence recovery rates were not different among the groups. At 24 months, men in the TR group had a higher EFR rate on univariate analysis ( p=0.036), and multivariate analysis ( p=0.03). Conclusion: TTP biopsy was not associated with markers of a more difficult RARP or worse oncological and continence recovery outcomes but did appear to impact upon long-term rates of EFR. Level of evidence: Level 4.

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