Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique.
Sood A, Klett DE, Abdollah F, Sammon JD, Pucheril D, Menon M, Jeong W, and Peabody JO. Robot-assisted partial cystectomy with intraoperative frozen section examination: Evolution and evaluation of a novel technique. Investig Clin Urol 2016; 57(3):221-228.
Investig Clin Urol
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.
Medical Subject Headings
Aged; Cystectomy; Female; Follow-Up Studies; Frozen Sections; Humans; Intraoperative Care; Male; Margins of Excision; Middle Aged; Operative Time; Patient Satisfaction; Quality of Life; Robotic Surgical Procedures; Specimen Handling; Ultrasonography; Urinary Bladder Neoplasms