This video demonstrates the detailed process of grossing a radical prostatectomy specimen, specifically one removed robotically (Da Vinci). The key challenge emphasized is initial orientation, which is established using anatomical landmarks (bladder neck/base, Apex/urethral margin, posterior seminal vesicles/vas deferens) and sometimes an anterior surgical stitch. The procedure involves precise measurements (weight and size), standardized inking of the margins (Right: Black, Left: Blue), and removal and coning of the apical and base margins for separate submission. Due to the presence of Benign Prostatic Hyperplasia (BPH), the specimen is noted as abnormally large. The final step involves serially sectioning and systematically submitting the entire prostate gland from Apex to Base using a repeating color pattern (black, blue, blue, black) across multiple cassettes, followed by the submission of the vas deferens and seminal vesicle resection margins.
Grossing a Radical Prostatectomy Specimen
0:11 Establishing Orientation: The video focuses on orienting the prostate, noting that specimens from robotic (Da Vinci) surgeries are generally cleaner.
Key Detail: The broad, burnt area is the bladder neck margin (base margin). The opposite end is the Apex (urethral margin).
0:55 Posterior Anatomy: The vas deferens and seminal vesicles (SV) run along the posterior base. These are key for identifying right and left sides.
1:20 Using the Urethra: A probe is inserted through the prostatic urethra to confirm the flow axis and delineate Right/Left, Apex/Base, and Anterior/Posterior.
1:45 Surgical Marking & Measurement: A temporary stitch is typically placed along the anterior side during robotic removal.
Measurement: The specimen weighed 94.6g and measured 4.1 x 4.8 x 4.7 cm.
2:49 Inking Procedure: The specimen is inked to identify margins: Right side is inked black, and the Left side is inked blue.
3:24 Margin Sectioning (Coning): The apical margin is removed first, followed by the base margin (which is typically larger).
Key Detail: The prostate is noted as abnormally large (about twice its normal size), consistent with gross Benign Prostatic Hyperplasia (BPH).
Submission: Both apical and base margins are "coned" (sliced) and submitted into separate cassettes, maintaining consistent thickness.
5:02 Trim Weight and Fixation: After removing the vas and seminal vesicles, the trim weight was 86.2g. The specimen was noted to be poorly fixed (fleshy) due to late arrival and insufficient overnight fixation.
7:04 Gross Description Philosophy: The description of the cut surface is intentionally vague (e.g., "granular cut surface with marked areas of nodularity/BPH").
Key Takeaway: Since the entire prostate is submitted, the gross description is minimal, deferring the precise identification and measurement of cancer lesions to the microscopic examination by the pathologist.
7:47 Submitting the Gland: The entire prostate is serially sectioned from Apex to Base. Due to the large size, slices are cut into six pieces to fit cassettes.
8:58 Systematic Submission Pattern: The sections are submitted sequentially in a repeating color pattern to track orientation: Black, Blue, Blue, Black (repeating this sequence for all slices).
10:28 Submitting Vas/Seminal Vesicles: The distal resected segments of the vas deferens and seminal vesicles are submitted separately as the resection margin, using the ink colors (right/left) for identification.