Dissection of the Apex

The apex is the principal location of positive margins in pT2 tumors, indicating that particular attention should be paid during this step.

At the present time, the urethra is kept intact during all of the apical dissection and used as a landmark: laterally, it helps to identify the junction between the prostate, the urethra, and the neu-rovascular bundle, and the contours of the prostate are then followed until the neurovascular bundle is totally freed. The urethra is therefore the last structure transected. This modification has certainly contributed to a reduction of the positive margin rate to about 3% in pT2 tumors.

At the present time, the urethra is kept intact during all of the apical dissection and used as a landmark: laterally, it helps to identify the junction between the prostate, the urethra, and the neurovascular bundle, and the contours of the prostate are then followed until the neurovascular bundle is totally freed. The urethra is therefore the last structure transected. This modification has certainly contributed to a reduction of the positive margin rate to about 3% in pT2 tumors.

Analyzing the Specimen

Once the prostate is freed, the specimen is extracted immediately for macroscopic examination. The purpose of this step is to adjust for the lack of intraoperative tactile feeling of laparoscopy and to ascertain oncological safety by giving the surgeon a chance to resect additional tissue based on the gross examination and/or frozen section results.

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