Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique

Autor: Akshay Sood, Dane E. Klett, Firas Abdollah, Jesse D. Sammon, Dan Pucheril, Mani Menon, Wooju Jeong, James O. Peabody
Jazyk: angličtina
Rok vydání: 2016
Předmět:
Zdroj: Investigative and Clinical Urology, Vol 57, Iss 3, Pp 221-228 (2016)
Druh dokumentu: article
ISSN: 2466-0493
2466-054X
DOI: 10.4111/icu.2016.57.3.221
Popis: Purpose: To describe a novel modification to robot-assisted partial cystectomy (RAPC) that allows for intraoperative surgical margin assessment by bimanual-examination and frozen-section analysis. Materials and Methods: A total of 7 patients underwent RAPC at a single tertiary-care institution between 2008 and 2013. The technique evolved over the study-period and permitted real-time intraoperative surgical margin evaluation in the last 5 patients via bimanual-examination and frozen-section analysis, utilizing the GelPOINT platform (a hand-assist device). The GelPOINT platform was placed through a 4- to 5-cm vertical supraumbilical incision and allowed for rapid retrieval of the bladder specimen without compromising the pneumoperitoneum or prolonging the operative time. Perioperative, oncological and functional outcomes were evaluated; all patients had a minimum 12-month follow-up. At the time of last follow-up, a cross-sectional survey of patients was performed to evaluate regret/satisfaction utilizing validated questionnaires. Results: The mean age was 72.5 years; 71.4% of the patients were men (n=5). All patients underwent RAPC for a malignant indication. The mean operative and console times were 291 and 217 minutes, respectively. No patient had a positive surgical margin. Mean length-of-stay was 1.7 days. At a median follow-up of 38.9 months, 1 patient experienced a local recurrence 6 months postsurgery. The only mortality was secondary to Lewy-body disease, in the same patient, 1 year postoperatively. Patient assessment of regret and satisfaction indicated 0% regret and 0% dissatisfaction. Conclusions: The ‘modified’ technique of RAPC is technically feasible, safe, and reproducible; further, RAPC leads to favorable oncological, functional and quality-of-life outcomes in patients eligible for partial cystectomy.
Databáze: Directory of Open Access Journals
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