You have accessJournal of UrologyRobotics, Single Port Surgery, LESS, NOTES1 Apr 2013V2156 BIMANUAL EXAMINATION OF RETRIEVED SPECIMEN AND REGIONAL HYPOTHERMIA DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY Wooju Jeong, Khurshid R. Ghani, Akshay Sood, Stacey Dusik, Ramesh Kumar, Craig G. Rogers, Nilesh S. Gupta, Prokar Dasgupta, James O. Peabody, and Mani Menon Wooju JeongWooju Jeong Detroit, MI More articles by this author , Khurshid R. GhaniKhurshid R. Ghani Detroit, MI More articles by this author , Akshay SoodAkshay Sood Detroit, MI More articles by this author , Stacey DusikStacey Dusik Detroit, MI More articles by this author , Ramesh KumarRamesh Kumar Detroit, MI More articles by this author , Craig G. RogersCraig G. Rogers Detroit, MI More articles by this author , Nilesh S. GuptaNilesh S. Gupta Detroit, MI More articles by this author , Prokar DasguptaProkar Dasgupta London, United Kingdom More articles by this author , James O. PeabodyJames O. Peabody Detroit, MI More articles by this author , and Mani MenonMani Menon Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2065AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We Modified our robotic prostatectomy procedure using the GelPOINT̈ 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. METHODS 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 GelPOINT̈ 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. RESULTS 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. CONCLUSIONS 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. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e883 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wooju Jeong Detroit, MI More articles by this author Khurshid R. Ghani Detroit, MI More articles by this author Akshay Sood Detroit, MI More articles by this author Stacey Dusik Detroit, MI More articles by this author Ramesh Kumar Detroit, MI More articles by this author Craig G. Rogers Detroit, MI More articles by this author Nilesh S. Gupta Detroit, MI More articles by this author Prokar Dasgupta London, United Kingdom More articles by this author James O. Peabody Detroit, MI More articles by this author Mani Menon Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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