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Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK

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Abstract

The purpose is to report the United Kingdom’s largest single-centre experience of robotically assisted laparoscopic radical prostatectomies (RALP), using the neurovascular structure-adjacent frozen-section (NeuroSAFE) technique. We describe the utilisation and outcomes of this technique. This is a retrospective study from 2012 to 2019 on 520 patients undergoing NeuroSAFE RALP at our Institution. Our Institution’s database was analysed for false-positive frozen-section (FS) margins as confirmed on paraffin histopathological analysis: functional outcomes of potency, continence, and biochemical recurrence (BCR). The median (range) of console time was 145 (90–300) min. In our cohort, positive FS was seen in 30.7% (160/520) of patients, with a confirmatory paraffin analysis in 91.8% of our patients’ cohort (147/160). The neurovascular bundles (NVBs) that underwent secondary resection contained tumour in 26.8% (43/160) of the cases. Biochemical recurrence (BCR) was 6.7% (35/520), of which FS was positive in 40% (14/35) of those cases. There were insufficient evidence of a statistical association of urinary incontinence and positive surgical margin rates according to NS or NVB resection. NeuroSAFE enables intraoperative confirmation of the oncologic safety of a NS procedure. Patients with a positive FS on NeuroSAFE can be converted to a negative surgical margin (NSM) by ipsilateral wide resection. This spared 1 in 4 men from positive margins posterolaterally in our series. Limitations are the absence of a matched contemporary cohort of NS RALP without NeuroSAFE in our centre.

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Acknowledgements

The authors would like to thank Venkat Prasad, Shan Gowrie Mohan, and Jerry Dimzon.

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Author notes

  1. Jim Adshead and Nikhil Vasdev are joint senior authors.

Authors and Affiliations

  1. Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK

    Jonathan Noël, Siya Lodia, Seiver Karim, Surina Taneja, Darius Moghanchizadeh, Arvind Nayak, Ashwin Tamhankar, Tim Lane, Jim Adshead & Nikhil Vasdev

  2. University of Hertfordshire, Statistical Services and Consultancy Unit, Hatfield, UK

    Neil H. Spencer

  3. Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK

    Seema Angra, Rajiv Swamy, Samita Agarwal & Ashish Narula

  4. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK

    Nikhil Vasdev

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  1. Jonathan Noël
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Correspondence to Jonathan Noël.

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Conflict of interest

The author Jonathan Noël, author Neil H. Spencer, author Siya Lodia, author Seiver Karim, author Surina Taneja, author Darius Moghanchizadeh, author Arvind Nayak, author Ashwin Tamhankar, author Seema Angra, author Rajiv Swamy, author Samita Agarwal, author Ashish Narula, author Tim Lane, author Jim Adshead and author Nikhil Vasdev declare that they have no conflicts of interest.

Ethical approval

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all the patients for being included in the study.

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Noël, J., Spencer, N.H., Lodia, S. et al. Neurovascular structure-adjacent frozen-section examination robotic-assisted radical prostatectomy: outcomes from 500 consecutive cases in the UK. J Robotic Surg 16, 951–956 (2022). https://doi.org/10.1007/s11701-021-01324-2

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