Initial Experience with Confocal Laser Scanning Microscopy for Intraoperative Margin Assessment During Robot-Assisted Radical Prostatectomy

INTRODUCTION: Current approaches to intraoperative margin assessment (IOMA) during robot-assisted radical prostatectomy (RARP) remain limited by time and resource demands. We evaluated the feasibility of confocal laser microscopy (CLM) using the Histolog Scanner (HS) for IOMA during RARP. METHODS: Data was collected from thirteen patients undergoing RARP. Thirty-four margins were scanned using the HS. Primary outcomes were feasibility and workflow integration. Secondary outcomes included concordance of surgeon and pathologist interpretation with final pathology. RESULTS: All scans produced interpretable images without technical failure, device-related adverse events, or interference with standard pathology processing. Mean scan time was 4.17 minutes per margin. Mean review time was 1.47 minutes for the surgeon and 2.69 minutes for the pathologist. Per-margin inter-rater agreement was 93.1%, with an overall accuracy of 86.2%. CONCLUSIONS: CLM via the HS provides a viable platform for IOMA during RARP. Larger studies are needed to define diagnostic performance and clinical utility.