Bimanual examination of the retrieved specimen and regional hypothermia during robot-assisted radical prostatectomy: a novel technique for reducing positive surgical margin and achieving pelvic cooling.
OBJECTIVE
To describe a novel method of achieving pelvic hypothermia during robot-assisted radical prostatectomy (RARP) and a modification of technique allowing immediate organ retrieval for intraoperative examination and targeted frozen-section biopsies.


METHODS
Intracorporeal cooling and extraction (ICE) consists of a modification of the standard RARP technique with the use of the GelPOINT™ (Applied Medical, Rancho Santa Margarita, CA, USA), a hand access platform, which allows for delivery of ice-slush and rapid specimen extraction without compromising pneumoperitoneum.


RESULTS
The ICE technique reproducibly achieves a temperature of 15 °C in the pelvic cavity with no obvious body temperature change. Adopting this technique during RARP, there was an absolute risk reduction by 26.6% in positive surgical margin rate in patients with pT3a disease when compared with similar patients undergoing conventional RARP (P = 0.04).


CONCLUSIONS
The ICE technique eliminates the potential handicap of decreased tactile sensation for oncological margins, especially in the high-risk patients. This technique allows the surgeon to immediately examine the surgical specimen after resection, and with the aid of frozen-section pathology determine if further resection is required. A prospective trial is underway in our centre to evaluate the effects of this novel technique on postoperative outcomes.
Vattikuti Urology Institute, Detroit, MI, USA.
Wooju
W
Jeong
Akshay
A
Sood
Khurshid R
KR
Ghani
Dan
D
Pucheril
Jesse D
JD
Sammon
Nilesh S
NS
Gupta
Mani
M
Menon
James O
JO
Peabody
D006801:Humans; D007036:Hypothermia, Induced / Q000295:instrumentation / Q000379:methods*; D008297:Male; D011467:Prostate / Q000601:surgery; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000295:instrumentation / Q000379:methods*
hypothermia; minimally invasive surgery; prostate cancer; prostatectomy; robotics