Improving Radical Prostatectomy with the 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. Alternatives, such as ex vivo fluorescence confocal microscopy (FCM), can quickly generate digital scans of unfixed specimens with minimal tissue preparation and consumables. The LaserSAFE technique is a new FCM method that uses the Histolog Scanner to process intact RARP specimens and scan the entire posterolateral surface of the prostate. This study evaluated 31 RARP specimens with a median prostate volume of 34.5 mL, it 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.

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Photo by CDC on Unsplash

Photo by CDC on Unsplash

Why is it important?

The current standard to guide surgical decisions during radical prostatectomy is called NeuroSAFE, but is time consuming, requires technical expertise and therefore its uptake has been limited. The technique described in this paper has the potential to replace NeuroSAFE as it is faster, does not damage the specimen, and can provide real-time analysis in centres that currently lack the necessary resources. Key Takeaways: 1. The FCM based LaserSAFE technique uses the Histolog Scanner to process intact RARP specimens and has the potential to replace the NeuroSAFE and FCM techniques. 2. 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.