MP80-07 POSTERIOR RECONSTRUCTION OF THE RHABDOSPHINCTER IMPROVES EARLY RECOVERY OF URINARY CONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

AND OBJECTIVES: To describe the feasibility and early outcomes of a Modification to robot-assisted radical prostatectomy (RARP) that allows for mitigation of the lack of tactile feedback during RARP by allowing immediate Organ Retrieval for Examination and targeted frozen-section biopsies (MORE technique). METHODS: MORE consists of a GelPOINT device inserted periumbilically. Prostate is excised and retrieved through the GelPOINT without undocking the robot, and examined bimanually on-table by the surgeon. Lesions suspicious for positive surgical margin (PSM) are sent for frozen section analysis (Figure). Biopsies positive/suspicious for cancer resulted in more tissue excision from the corresponding pelvic bed site. 352 patients with a probability of extracapsular extension (EPE) >25% (Partin table) were selected to undergo MORE RARP. MORE RARP patients with pT3a at final pathology (n1⁄4103) were compared to a control group of 74 consecutive patients with pT3a after conventional RARP. RESULTS: Except a greater proportion of clinically palpable disease in the MORE RARP vs. control group (43.7 vs. 17.6%; p1⁄40.005), the two groups had comparable rates of nodal dissection, nerve sparing, pathological stage, grade and nodal status. The PSM rate in the MORE group was 17.5% (18/103) compared to 36.5% (27/74) in the control group (p1⁄40.004); the odds ratio was 0.37 (CI: 0.18-0.74; p1⁄40.005). 8 patients in each group had biochemical recurrence; short follow-up (median 16.6 and 15.4 months respectively) precluded detection of any significant difference. Frozen section biopsy site matched the EPE site at final pathology in 59/79 (73.4%) cases selected for frozen section analyses. CONCLUSIONS: Adoption of the MORE technique led to a significant reduction in the PSM rate following RARP in patients harboring locally advanced disease without increasing operative time. Its easy reproducibility may also allow potential utility in other robotassisted urologic oncologic procedures. Source of Funding: none