Robot-assisted PSMA-radioguided surgery to assess surgical margins and nodal metastases in prostate cancer patients: report on three cases using an intraoperative PET-CT specimen imager.

The aim of this feasibility study was to test the intraoperative use of this brand-new specimen PET/CT to guide robot-assisted radical prostatectomy (RARP) and pelvic lymph node dissection (PLND). Three cases of RARP and PLND were performed with intraoperative use of the specimen imager.

Surgeries were performed with Da Vinci Xi robot. An intravenous injection of 68Ga-PSMA-11 was performed in the OR and after complete excision, the specimens were analysed with the imager.

the average nodal yield was 17.3 (5.8 SD) nodes per patient. Specimen PET/CT images showed a focal uptake in a metastatic node (TBR 13.6), and no uptake or diffuse, faint uptake in negative nodes (TBR range: 1-5.3). The specimen imager provided intraoperative PET/CT images that clearly showed negative surgical margins in two patients, whereas the results were uncertain in a locally advanced case.

the intraoperative use of the specimen PET/CT imager is safe and feasible and could improve the evaluation of prostate surgical margins and lymph node status.

Urology. 2023 Sep 03 [Epub ahead of print]

Marco Oderda, Serena Grimaldi, Guido Rovera, Luisa Delsedime, Daniele D'Agate, Federico Lavagno, Alessandro Marquis, Giancarlo Marra, Luca Molinaro, Desireé Deandreis, Paolo Gontero

Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Italy. Electronic address: ., Nuclear Medicine, Department of Medical Sciences, AOU Città della Salute e della Scienza di Torino, University of Turin, Italy., Department of Pathology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Italy., Department of Surgical Sciences, Urology Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, University of Turin, Italy.

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