This video details the standard operating procedure for the gross examination and sectioning of a radical prostatectomy specimen, typically removed using the Da Vinci robotic system. The process emphasizes meticulous orientation, utilizing anatomical landmarks such as the bladder neck (base), apex (urethral margin), and the attached seminal vesicles/vas deferens. The specimen is weighed, measured, and the surgical margins are differentially inked (black for right, blue for left). The protocol includes the coning and submission of the apical and base margins first, followed by the serial sectioning and complete submission of the remaining prostate gland. The pathologist notes that gross interpretation is secondary, as the entire specimen is submitted for definitive microscopic pathology, and highlights the presence of marked nodularity consistent with Benign Prostatic Hyperplasia (BPH).
Grossing a Radical Prostatectomy Specimen
0:11 - 1:43 Specimen Orientation: Orientation is identified as the most crucial and difficult part of the procedure. The base (bladder neck margin) is recognized as the broad, "scabrous" burnt area. The vas deferens and seminal vesicles mark the posterior base. The apex is the urethral margin. A probe is used through the prostatic urethra to confirm orientation (Right, Left, Anterior, Posterior).
1:47 Surgical Marker: A stitch is often visible along the anterior side of the prostate, placed during the robotic surgery to help remove the gland.
2:01 - 2:38 Initial Measurements: The specimen is weighed (94.6g) and its dimensions are recorded (e.g., 4.1 cm length, 4.8 cm width).
2:41 - 3:00 Margin Inking: The anterior orientation stitch is removed, and a probe is reinserted. Margins are differentially inked: the right side is inked black, and the left side is inked blue.
3:24 - 4:10 Apical Margin Submission: The apical margin is removed first. The prostate is noted to be abnormally large (about twice normal size) due to marked BPH. The margin is "coned" (sliced thinly and uniformly) and submitted in a cassette, typically embedded on edge.
4:10 - 4:42 Base Margin Submission: The base margin (bladder neck) is removed, coned, and submitted in a second cassette, also aiming for consistent thickness.
5:00 - 5:28 Serial Sectioning Preparation: The vas deferens and seminal vesicles are detached. The prostate's trim weight (86.2g) is recorded.
5:30 - 7:04 Serial Sectioning: The prostate gland is serially sectioned from Apex to Base, maintaining consistent thickness. A practical note is made that the specimen was poorly fixed (fleshy) due to arriving late the previous night.
7:04 - 7:45 Gross Description and Takeaway: The resulting cut surface is described vaguely (tan-white, granular, with marked nodularity consistent with BPH). The pathologist emphasizes that since the entire gland is submitted, the gross description is secondary, as microscopic evaluation is necessary for accurate diagnosis.
7:47 - 10:13 Complete Gland Submission: The entire serially sectioned prostate is submitted by cutting the slices into smaller segments (e.g., four or six pieces) to fit standard cassettes. The pieces are submitted sequentially following a precise, repeating pattern based on the ink colors (e.g., Black, Blue, Blue, Black, repeated).
10:28 - 11:00 Final Submission: The attached vas deferens and seminal vesicles (right and left) are sectioned and submitted as the final resection margin.