title: Intraoperative Optical Biopsy during Robotic Assisted Radical Prostatectomy Using Confocal Endomicroscopy.
abstract: Intraoperative optical biopsy technologies may aid in the identification of important anatomical landmarks and improve surgical outcomes of robotic assisted radical prostatectomy. We evaluate the feasibility of confocal laser endomicroscopy during robotic assisted radical prostatectomy.
  
  
  
  A total of 21 patients with biopsy proven prostate cancer scheduled for robotic assisted radical prostatectomy were recruited. After intravenous administration of fluorescein 15 patients underwent in vivo intraoperative confocal laser endomicroscopy of prostatic and periprostatic structures using a 2.6 or 0.85 mm imaging probe. Standard robotic instruments were used to grasp and maneuver the confocal laser endomicroscopy probes for image acquisition. Confocal laser endomicroscopy imaging was performed ex vivo on fresh prostate specimens from 20 patients. Confocal video sequences acquired in vivo and ex vivo were reviewed and analyzed, with additional image processing using a mosaicing algorithm. Processed confocal images were compared with standard hematoxylin and eosin analysis of imaged regions.
  
  
  
  Confocal laser endomicroscopy was successfully integrated with robotic surgery, including co-registration of confocal video sequences with white light and probe handling with standard robotic instrumentation. Intraoperative confocal laser endomicroscopy imaging of the neurovascular bundle before and after nerve sparing dissection revealed characteristic features including dynamic vascular flow and intact axon fibers. Ex vivo confocal imaging of the prostatic parenchyma demonstrated normal prostate glands, stroma and prostatic carcinoma.
  
  
  
  We report the initial feasibility of optical biopsy of prostatic and periprostatic tissue during robotic assisted radical prostatectomy. Image guidance and tissue interrogation using confocal laser endomicroscopy offer a new intraoperative imaging method that has the potential to improve the functional and oncologic outcomes of prostate cancer surgery.
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Aristeo
authors.initials: A
authors.lastname: Lopez
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Dimitar V
authors.initials: DV
authors.lastname: Zlatev
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Kathleen E
authors.initials: KE
authors.lastname: Mach
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bui
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Jen-Jane
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.|Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305.
authors.forename: Robert V
authors.initials: RV
authors.lastname: Rouse
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Theodore
authors.initials: T
authors.lastname: Harris
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: John T
authors.initials: JT
authors.lastname: Leppert
authors.affiliation: Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118.|Veterans Affairs Palo Alto Health Care System, Palo Alto, CA 94304.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Liao
mesh_terms: D000368:Aged; D001706:Biopsy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D011467:Prostate / Q000473:pathology*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: erectile dysfunction; microscopy, confocal; prostatectomy; prostatic neoplasms; surgery, computer-assisted