available for prostate biopsy and intervention. In order to track and record the 3D coordinates of each biopsy, one requires either an imaging-tracking tool with 3D TRUS imaging, a GPS-tracking sensor mounted 2D TRUS probe, or a tracking system digitally linked to the physical 3D positioning system. The robotic delivery system has po- tential for automated and reproducible delivery of a biopsy needle or focal therapy probe. Augmented reality of 3D estimated treated area onto the real time US imaging and surgical planning 3D model may enhance the precision of the delivery of ablative needle. CONCLUSIONS: The emerging tools, which could support image-navigation of prostate intervention for active surveillance and focal therapy, include refined imaging modalities, 3D modeling for planning and tracking intervention, elastic fusion image technology, and automated mechanical delivery of the intervention needle. Source of Funding: None V1221 INTRAOPERATIVE USE OF A PROSTATE SPECIFIC MEMBRANE ANTIGEN-BASED FLUORESCENT IMAGING AGENT FOR PROSTATE CANCER IN A MOUSE MODEL John Eifler*, Wasim Chowdhury, Mark Castanares, Catherine Foss, Netto George, Martin Pomper, Ronald Rodriguez, Baltimore, MD INTRODUCTION AND OBJECTIVES: The identification and elimination of positive surgical margins remains a goal of prostate cancer surgery. Recently a low-molecular weight agent that targets the prostate specific membrane antigen (PSMA) and emits light in the near infrared (NIR) range, YC-27, was developed at our institution. METHODS: In the first experiment, 6  10 5 PSMA-expressing human prostate cancer cells (LNCaP) were incubated with 10 nM YC-27 for thirty minutes. This suspension was washed three times, and injected subcutaneously in the flank of a nude mouse. An additional 6  10 5 LNCaP cells that were not incubated with YC-27 were injected in the opposite side. A NIR based imager (Fluobeam; Fluoptics, Grenoble, France) was used in addition to visible light to detect LNCaP cells intraoperatively in real-time. In a second experiment, human prostate cancer cells (PC3-PIP) was injected orthotopically into a nude mouse. Sixteen days later, YC-27 was injected intravenously. After 24 hours, the mouse was sacrificed and explored using the Fluobeam. RESULTS: Peak emission of YC-27 occurred near 800 nm and was visible through the skin. PSMA-positive prostate cancer cells (LNCaP) were visible when incubated with the agent, while LNCaP cells not incubated with YC-27 were not detected. NIR fluorescence imaging allowed real-time detection and removal of a human prostate cancer cell suspension that was invisible in white light. Furthermore, a 2mm human prostate tumor (PC3-PIP) was detected with fluorescence imaging and histologically proven to be prostate cancer. CONCLUSIONS: A PSMA-binding small molecule that emits in the NIR range allows real-time, intraoperative identification of small tumor burdens. This agent may be useful for laparoscopic, robotic, or open prostate surgery and warrants further study. Source of Funding: U24 CA92871 R01 CA134675 V1222 INDOCYANINE GREEN (ICG®) IN PROSTATE CANCER LYMPH NODE DISSECTION Vincent Flamand, Lille, France; Rafael Sanchez-Salas*, Franc ¸ois Rozet, Marc Galiano, Xavier Cathelineau, Eric Barret, Guy Vallancien, Paris, France INTRODUCTION AND OBJECTIVES: The benefits of ex- tended lymph node dissection (eLND) in localized prostate cancer (PCa) remain controversial. The concept of sentinel node/mapping might be a potential tool to rationalize lymphatic surgical dissection in PCa. METHODS: Pilot Prospective feasibility study of ICG® and LND. Ten patients with localized intermediate to high risk PCa were enrolled. Technique: Under ultrasound guidance a prostatic bilobar injection of ICG was performed one hour prior to eLND. Infrared fluorescent light was deployed to verify lymph node appearance after the injection. A prototype camera from Olympus® which allows to switch between standard and infrared vision was used. A specific determination of fluorescent nodes was initially performed in every procedure. eLND was undertaken afterwards. For each side, the two sets of nodes were sent separately for histological examination. RESULTS: The median number of resected nodes was 11 [5–28]. The fluorescent identification of marked nodes was readily accomplished. No eLND reported a positive lymph node in either frozen section or final pathology. No complications occurred. CONCLUSIONS: This technique appeals as a potential ele- ment to further evaluate in order to optimize the approach of patients with potential node disease in PCa. Source of Funding: None V1223 ROBOT-ASSISTED LAPAROSCOPIC PROSTATECTOMY - RETROGRADE APPROACH: PHASE I TRIAL Jose Leonardo Gonzalez*, Gustavo Pena-Lagrave, Kishore Thekke-Adiyat, Juan Ramos, Maria F. Bianco, Fernando J. Bianco, Miami, FL INTRODUCTION AND OBJECTIVES: Advantages of the retro- grade approach during robot-assisted radical prostatectomy (RALP) consist of a precise dissection of the prostatic apex, front access to the distal neurovascular bundles (NVB) and distal prostatic elevation. How- ever, there are potential caveats such as increased risk of bleeding and risk of rectal injury. We designed a toxicity trial to evaluate for such events. METHODS: Phase I trial with the primary toxicity endpoint of rectal injury. Secondary endpoints were blood loss, transfussion rates, apical positive margins and 3 month trifecta outcomes. Men with preoprative PSA  20 ng/ml, Clinical stage T1c-T2 and a biopsy Gleason score  7 were elegible and offered to participate in this trial. RESULTS: Trial was conducted between January and June 2010. 26 men participated. We observed no rectal injuries. Median (Mean) operative time was 140 (144) minutes. The Median estimated blood loss was 200 cc (range 50 – 400). One patient received 2 units of pack red blood cells. There were no urinary leaks. The NVB were dissected intrafascially on the right and left side in 17 and 20 patients, respectivelly. pT2 tumors were present in 23 patients with one having positive apical margin. One of the 3 patients with pT3 tumors had an apical positive margin. 22 patients received node dissections, the median count was 9 (range 4 –16) and it was one patient had nodal disease. All patient complete their 3 month outcome evaluation, all, had an undetectable serum PSA. Of 20 men with a baseline SHIM score with or without PDE5 inhibitors greater than 18, 8 (40%) remained with a score of 18 or better. No men wore pads before surgery, at 3 months 15/26 (58%) did not wear pads, 5 (19%) wore one pad a day and the remainder 6 required 2 or more pads per day. The median IPSS score was 5, ranging from 0 –14. CONCLUSIONS: Retrograde dissection during RALP is feaseble, reproducible and safe. There was no incremental blood loss associated with the dissection. It eased the distal release of the NVBs. Source of Funding: None e490 THE JOURNAL OF UROLOGY Vol. 185, No. 4S, Supplement, Monday, May 16, 2011