V2156: BIMANUAL EXAMINATION OF RETRIEVED SPECIMEN AND REGIONAL HYPOTHERMIA DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY
VideoIntroduction and Objectives
We Modified our robotic prostatectomy procedure using the GelPOINT¨ access port to allow immediate Organ Retrieval for on-table Examination and targeted frozen section biopsies, or the MORE procedure, and to induce regional hypothermia by putting ice slush into the pelvic cavity. The goal of these new techniques is to determine if bimanual palpation of the specimen can help reduce the positive surgical margin (PSM) rate in pT3a disease through immediate evaluation of the prostate specimen and to evaluate the feasibility of achieving regional hypothermia during the RARP.
117 patients were selected to undergo MORE-RARP procedure. Regional hypothermia procedures were performed in 32 out 117 MORE-RARP patients. MORE consists of a GelPOINT¨ access port placed in the periumbilical region with a 12mm camera port and 10mm port, which enables the assistant to retrieve the specimen and introduce iced saline slush into the pelvic cavity. The configuration of other ports is same as for conventional robotic prostatectomy.
Following excision of the prostate, it is retrieved through GelPOINT and examined on-table by the surgeon, and can be sent for frozen section analysis while the console surgeon performs lymph node dissection. Lesions suspicious for positive margins are sent for frozen section biopsy. If biopsies are positive or suspicious for cancer, more tissue is removed from the area overlying the positive margin (n=10). Iced saline is introduced using a rigid sigmoidoscope through GelPOINT during the procedure. A 9F esophageal temperature probe was used to measure the temperature of the pelvic cavity. The other steps of the robotic prostatectomy are same as for a conventional procedure.
In the MORE group, 30/117 patients were diagnosed with pT3a disease. There were no significant differences in baseline characteristics between control patients and patients undergoing MORE procedure. Total operating times between MORE and control groups were not significantly different. The pT3a PSM rate in the control group was 43.3% compared to 16.7% in MORE. 2/10 specimen had adenocarcinoma from the additional tissue. Using iced saline during RARP, this technique achieved temperature of 15 ¡C in the pelvic cavity with no obvious body temperature change.
In this pilot study, adoption of the MORE procedure at RARP led to a significant reduction in the PSM rate in pT3a prostate cancer. We have demonstrated the feasibility of a novel technique of regional hypothermia using iced saline during RARP and this technique was reproducible.