Upcoming event
Masterclass on Focal therapy for localised prostate cancer
Back

Digital Frozen Sections with Fluorescence Confocal Microscopy During Robot-assisted Radical Prostatectomy: Surgical Technique

  • Bernardo Rocco 1,
  • Luca Sarchi 1,
  • Simone Assumma 1,
  • Alessia Cimadamore 2,
  • Rodolfo Montironi 2,
  • Luca Reggiani Bonetti 3,
  • Filippo Turri 1,
  • Cosimo De Carne 1,
  • Stefano Puliatti 1,
  • Antonino Maiorana 3,
  • Giovanni Pellacani 4,
  • Salvatore Micali 1,
  • Giampaolo Bianchi 1,
  • Maria Chiara Sighinolfi 1
1 Department of Urology, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino Estense Modena, University of Modena and Reggio Emilia, Modena, Italy 2 Institute of Pathological Anatomy, Polytechnic University of the Marche Region, Ancona, Italy 3 Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy 4 Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy

Publication: European Urology, May 2021

https://www.sciencedirect.com/science/article/abs/pii/S030228382100227X?via%3Dihub

Background

Robot-assisted radical prostatectomy (RARP) involves a tradeoff between oncological control and functional outcomes. Intraoperative control of surgical margins (SMs) may help in ensuring the safety of the dissection. Fluorescence confocal microscopy (FCM) is an effective method for interpretation of prostate tissue and provides digital images with an appearance similar to hematoxylin-eosin staining.

Objective

To describe an alternative technique to NeuroSAFE for intraoperative evaluation of neurovascular-adjacent margins shaved from ex vivo specimens using FCM analysis.

Design, setting, and participants

This was a prospective study of 24 patients undergoing RARP with intraoperative FCM control of margin status.

Surgical procedure

After surgical dissection, SMs are sectioned from the fresh prostate using the Mohs technique (shaving): three slices from the apex and the right and left posterolateral aspects are obtained. Digital images of the shavings are immediately acquired via FCM and shared with a remote pathologist. In the case of a positive SM, a focal secondary resection of the bundle can be performed owing to the ability of FCM to locate a region of interest on the flat sample.

Measurements

The primary outcome measure was the rate of negative margins at neurovascular-adjacent sites. Oncological and functional outcomes for patients with 1 yr of follow-up are also reported.

Results and limitations

All patients had negative SMs in shavings from neurovascular-adjacent areas at final histopathology; four underwent a secondary resection with final conversion to negative SM status. Nine of ten patients with 1-yr follow-up are free of biochemical recurrence (prostate-specific antigen persistence in one pN1 case), nine are fully continent, and four of the five with preoperative potency have recovered their sexual function.

Conclusions

Digital frozen sections with FCM during RARP may represent an alternative to NeuroSAFE for possible optimization of functional outcomes without compromising oncological safety.