Investig Clin Urol.  2016 May;57(3):221-228. 10.4111/icu.2016.57.3.221.

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
• Peabody JO

• KMID: 2426498
• DOI: http://doi.org/10.4111/icu.2016.57.3.221

Abstract

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.

Keyword

Cystectomy; Frozen sections; Quality of life; Robotics; Urinary bladder neoplasms

MeSH Terms

Aged
Cystectomy/adverse effects/*methods/rehabilitation
Female
Follow-Up Studies
*Frozen Sections
Humans
Intraoperative Care/*methods
Male
Margins of Excision
Middle Aged
Operative Time
Patient Satisfaction
Quality of Life
Robotic Surgical Procedures/adverse effects/*methods/rehabilitation
Specimen Handling/methods
Ultrasonography
Urinary Bladder Neoplasms/diagnostic imaging/pathology/*surgery

Figure

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  Fig. 1 (A) GelSeal cap prepared with the 12-mm camera port and 10-mm sleeve port. (B) Port placement for robot-assisted partial cystectomy.

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  Fig. 2 (A, B) Concurrent cystoscopic and robotic view for accurate tumor demarcation.

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  Fig. 3 (A, B) Ultrasound confirmation of tumor location using the drop-down robotic ultrasound probe.

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  Fig. 4 (A-E) Progressive circumferential scoring of the peritoneal aspect of the bladder around the tumor with a 10- to 20-mm margin.

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  Fig. 5 (A) Extracting the partial cystectomy specimen for bimanual and frozen-section assessment. (B, C) Bimanual examination and frozen-section analysis.

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