Improving Radical Prostatectomy with LaserSAFE Technique

What is it about?

The NeuroSAFE technique is a safe and accurate method for guiding nerve-sparing decisions during robot-assisted radical prostatectomy (RARP), but its widespread use is limited by its time- and resource-intensive nature. Researchers have explored alternatives, such as ex vivo fluorescence confocal microscopy (FCM), which can quickly generate digital scans of unfixed specimens with minimal tissue preparation and consumables. The LaserSAFE technique is a new method that uses the Histolog Scanner to process intact RARP specimens and scan the entire posterolateral surface en face. The preliminary accuracy performance metrics of LaserSAFE were reported in a study that evaluated 31 RARP specimens with a median prostate volume of 34.5 mL. The study found a sensitivity of 87.5% and specificity of 98.1% for diagnosis of positive surgical margins (PSMs), with almost perfect agreement between LaserSAFE and final pathology analysis. The findings were limited to a single consultant uropathologist, and further blinded assessments and a feasibility study are currently underway. [Some of the content on this page has been created by AI]

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Why is it important?

This research is important for several reasons. Firstly, it addresses the uncertainty of whether the NeuroSAFE technique, which has been proven safe and accurate in guiding nerve-sparing decisions during robot-assisted radical prostatectomy (RARP), leads to better functional outcomes. The NeuroSAFE PROOF trial will generate Level 1 evidence to answer this question and is expected to provide results in mid-2024. Secondly, it explores potential alternatives to replace frozen section, such as ex vivo fluorescence confocal microscopy (FCM), which can quickly generate digital scans of unfixed specimens, requiring minimal tissue preparation and consumables. This has the potential to improve the efficiency and accuracy of surgical procedures. Finally, the research describes the LaserSAFE technique, which uses the Histolog Scanner to process intact RARP specimens, and reports its preliminary accuracy performance metrics. This technique has the potential to replace the NeuroSAFE and FCM techniques, as it is faster, does not damage the specimen, and can provide real-time analysis of positive surgical margins (PSMs) in centres that currently lack the necessary resources to perform NeuroSAFE. Key Takeaways: 1. The NeuroSAFE PROOF trial will generate Level 1 evidence to answer the question of whether the NeuroSAFE technique leads to better functional outcomes. 2. Ex vivo fluorescence confocal microscopy (FCM) is a potential alternative to replace frozen section and can quickly generate digital scans of unfixed specimens. 3. The LaserSAFE technique uses the Histolog Scanner to process intact RARP specimens and has the potential to replace the NeuroSAFE and FCM techniques. 4. The LaserSAFE technique is faster, does not damage the specimen, and can provide real-time analysis of PSMs in centres that currently lack the necessary resources to perform NeuroSAFE.