title: Intraoperative photodynamic evaluation of surgical margins during endoscopic extraperitoneal radical prostatectomy with the use of 5-aminolevulinic acid.
abstract: OBJECTIVE
  Today there are no established techniques to image positive surgical margins (PSM) intraoperatively in endoscopic extraperitoneal radical prostatectomy (EERPE). The intention of this study was to describe the specific technique of photodynamic diagnosis (PDD) in patients undergoing EERPE and report on the potential to detect PSM under PDD.
  
  
  METHODS
  Twenty-four patients with clinically organ-confined prostate cancer received 5-aminolevulinic acid 20 mg/kg body weight orally 3 hours prior to nonnerve-sparing EERPE. An endoscopic PDD system (Karl Storz, Tuttlingen, Germany) including a Tricam PDD 3-chip camera head linked with a straight 10-mm telescope and a D-light C system was used. During EERPE, visualization of the surgical margins was performed by means of both white light and PDD at specific steps during standardized prostatectomy in all patients. Positive PDD areas on the prostate specimen were marked with white ink and consequently processed in pathology.
  
  
  RESULTS
  In white light endoscopy, no suspicion of a PSM was raised. Six out of the eight PSM were detected by PDD. In two cases, areas of positive PDD findings were free of prostate cancer and two PSM were not detected by PDD ( one bladder neck, one lateral). The overall sensitivity and specificity were 75% and 88.2%, respectively.
  
  
  CONCLUSIONS
  Laparoscopy offers an appropriate setting for the use of PDD in prostate cancer to visualize possible PSM. Although imaging of PSM by PDD is promising with the technique being feasible and safe, larger series are needed to prove the reproducibility of our results.
authors: Department of Urology, University of Regensburg, Krankenhaus St. Josef, Regensburg, Germany. roman.ganzer@gmx.de
authors: Roman
authors: R
authors: Ganzer
authors: Andreas
authors: A
authors: Blana
authors: Stefan
authors: S
authors: Denzinger
authors: Wolf F
authors: WF
authors: Wieland
authors: Christoph
authors: C
authors: Adam
authors: Armin
authors: A
authors: Becker
authors: Wael
authors: W
authors: Khoder
authors: Sebastian
authors: S
authors: Walther
authors: Christian G
authors: CG
authors: Stief
authors: Dirk
authors: D
authors: Zaak
authors: Georg
authors: G
authors: Salomon
authors: Arndt
authors: A
authors: Hartmann
authors: Ruth
authors: R
authors: Knuechel
authors: Simone
authors: S
authors: Bertz
authors: Gralf
authors: G
authors: Popken
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage*; D001706:Biopsy; D004210:Dissection; D004724:Endoscopy; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D010778:Photochemotherapy; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D055815:Young Adult
chemical_list: D000622:Aminolevulinic Acid