Intraoperative margin assessment using fluorescence confocal microscopy during robot-assisted radical prostatectomy - a first experience

Sep 23, 2026

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Objective: evaluate feasibility of fluorescence confocal microscopy (FCM) for intraoperative assessment of positive surgical margins (PSMs) during robot-assisted radical prostatectomy (RARP) in routine clinical practice. Patients and methods: prospective observational study of consecutive RARP cases from Oct 2023 to Nov 2024; after exclusions, ex vivo intraoperative scanning was remotely and in real time reviewed by a blinded uropathologist, using final histopathology as reference. Results: 101 patients; 17% had PSMs. FCM accuracy was 91.1% for any PSM and 92.1% for clinically significant PSMs ≥3 mm. Conclusions: FCM-guided margin assessment is feasible with rapid turnaround times, with improved performance using clinically relevant thresholds.

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Objective

Patients and Methods

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Introduction

BJU Int 2026; 138: Supplement 1: S40–S48 doi:10.1111/bju.70262 Original Article Intraoperative margin assessment using ﬂuorescence confocal microscopy during robot-assisted radical prostatectomy: a ﬁ rst experience Mario de Angelis 1,12,13 , Edoardo Beatrici3,12,13, Natali Rodriguez Penaranda4,12,13 , Nicola Frego3,12,13, Stefano Resca4,12,13, Enrico Vecchio5,12,13, Attilio Barretta6,12,13 , Marco Ticonosco6,12,13, Claudio Brancelli7,12,13, Vincenzo Cavarra8,12,13, Alessio Guidotti9,12,13, Francesco Pepillo 11,12,13, Francesco Prata10,12 , Nicolas Carl12,15, Francesco Barletta2,12,13, Francesco Cei2,12,13 , Geert De Naeyer12,13, Edward Lambert 12,13, Kris Van Der Steen14, Ruben De Groote 12,13 and Alexandre Mottrie 12,13 1Department of Urology, European Institute of Oncology (IEO), IRCCS, 2Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, 3Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, 4Department of Urology, University of Modena and Reggio Emilia, Modena, 5Department of Urology, IRCCSOspedale Policlinico San Martino, University of Genova, Genoa, 6Division of Urology, IRCCS Azienda OspedalieroUniversitaria di Bologna, Bologna, 7Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, 8Department of Oncology, Fondazione Policlinico Universitario Agostino Gemelli, 9Department of Urology, Sant’Andrea Hospital, “Sapienza” University of Rome, 10Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, 11Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy, 12ORSI Academy, Melle, 13Department of Urology, Azorg Hospital, 14Department of Pathology, AZORG Hospital Aalst, Aalst, Belgium, and 15Medical Faculty, RuprechtKarls University of Heidelberg, Heidelberg, Germany MdA. and E. B. authors contributed equally to this work. Published as part of the themed issue on Fluorescent confocal microscopy in urological surgery. [https://bjui.pub/FCMicro](https://bjui.pub/FCMicro) Objective To evaluate the feasibility of adopting ﬂuorescence confocal microscopy (FCM) for intraoperative assessment of positive surgical margins (PSMs) during robot-assisted radical prostatectomy (RARP) in a real-world clinical setting. Patients and Methods We conducted a prospective observational study including consecutive patients undergoing RARP between October 2023 and November 2024 in whom intraoperative margin assessment was performed using FCM (Histolog􀀁 Scanner; SamanTree Medical SA, Lausanne, Switzerland) . After exclusion of initial learning-curve cases and non-interpretable scans, a per-patient analysis was performed. Prostate specimens were scanned ex vivo intraoperatively, and digital images were reviewed remotely and in real time by an experienced uropathologist blinded to ﬁnal pathology. Final histopathological evaluation served as the reference standard. Diagnostic performance metrics included sensitivity, speciﬁcity, positive predictive value (PPV), negative PV (NPV), and overall accuracy, assessed both for any PSM and for clinically signiﬁcant PSMs (≥3 mm) . Results A total of 101 patients were included in the ﬁnal analysis. The median (interquartile range) overall time from prostate extraction to intraoperative report was 13 (6–16) min. At ﬁnal pathology, 17 patients (17%) had PSMs. For detection of any PSM, FCM demonstrated a sensitivity of 88.2%, speciﬁcity of 91.7%, PPV of 68.2%, and NPV of 97.5%, with an overall diagnostic accuracy of 91.1% . When restricting the analysis to clinically signiﬁcant PSMs (≥3 mm), diagnostic performance improved, with sensitivity, speciﬁcity, PPV, and NPV of 93.8%, 91.8%, 68.2%, and 98.7%, respectively, and an overall accuracy of 92.1% . Conclusions Intraoperative surgical margin assessment using FCM is feasible and demonstrates good diagnostic accuracy compared with ﬁnal histopathology, wit

FAQs

What was the main objective of this study?

To evaluate whether fluorescence confocal microscopy can be used feasibly for intraoperative assessment of positive surgical margins during robot-assisted radical prostatectomy in real-world clinical settings.

How were patients and scans handled in the methods?

A prospective observational study included consecutive RARP patients between Oct 2023 and Nov 2024. After excluding learning-curve cases and non-interpretable scans, prostate specimens were scanned ex vivo intraoperatively and images were reviewed remotely and in real time by a blinded uropathologist.

How accurate was FCM for detecting positive surgical margins?

For any PSM, FCM showed sensitivity 88.2%, specificity 91.7%, and overall diagnostic accuracy 91.1%. For clinically significant PSMs (≥3 mm), sensitivity 93.8%, specificity 91.8%, and overall accuracy 92.1%.

Sep 23, 2026

Uploaded by Ben