more medially and preserve the capsular artery, thereby achieving a full nerve spare. Case 3: is a 47 year old man with a SHIM score of 25, and an intermediate risk grade cancer having a partial nerve sparing. In Case four, we show you the technique to protect the base during robot-assisted radical prostatectomy. All patients had negative surgical margins. CONCLUSIONS: Nerve sparing should be tailored according to the patient’s preoperative pathology as well as intraoperative tissue characteristics. Surgeon’s experience plays a key part. Preoperative pathology and intraoperative visual cues as well as attention to tissue planes are paramount to achieve good outcomes. Source of Funding: None V1275 IMPORTANT TECHNICAL MODIFICATIONS TO IMPROVE OUTCOMES IN ROBOTIC ASSISTED RADICAL PROSTATECTOMY - LESSONS LEARNED AFTER 5.000 CASES Camilo Giedelman*, Haidar Abdul Muhsin, Oscar Schatloff, Srinivas Samavedi, Rafael Coelho, Kenneth Palmer, Sanket Chauhan, Ananthakrishnan Sivaraman, Bernardo Rocco, Vipul Patel, Celebration, FL INTRODUCTION AND OBJECTIVES: We report the lessons learnt after 5000 cases of robot assisted radical prostatectomy, done by a single surgeon after an extended learning curve, showing key mod- ifications applied to improve outcomes. METHODS: The present study is a combination of (1) a litera- ture review, (2) presentation of a single surgeon experience of 5000 patients undergoing robotic assisted radical prostatectomy between 2008 and 2012 and (3) a compilation of technical implementations for in each step of the procedure. RESULTS: Regarding cancer control, which includes the PSM and BCR, we show strategies to reduce margin rates. In early return to continence, we report results of periurethral suspension stitch, bladder neck plication and posterior reconstruction of the rhabdosphincter. To improve potency outcomes, we present the key principles of our nerve sparing technique together with our anatomical approach to nerve spearing. Results obtained with the application of these lessons have led to continuous improvement of peri and postoperative outcomes. CONCLUSIONS: Robotic prostatectomy is still in evolution. Technical modifications resulting in improved oncological and func- tional outcomes are the result of increasing surgical experience and procedure understanding. Source of Funding: None V1276 ROBOT ASSISTED MANAGEMENT OF BENIGN OBSTRUCTING LARGE PROSTATE GLANDS GREATER THAN 150GM Mathew Oommen*, Kush Patel, Philip Dorsey, Janet Colli, Arthur Caire, Michael Pinsky, Benjamin Lee, Raju Thomas, New Orleans, LA INTRODUCTION AND OBJECTIVES: Urologists perform over 500,000 invasive procedures annually for benign symptomatic urinary outflow obstruction. In general, transurethral resection with either bipo- lar/laser techniques are more than adequate. For glands larger than 150gm, the gold standard has been the open suprapubic approach. In this video, we present our techniques for a robot assisted suprapubic prostatectomy. METHODS: A single institution’s experience with robot assisted suprapubic prostatectomy for large benign prostate glands is pre- sented. Techniques to facilitate this procedure such as use of the robotic tenaculum, management of a large median lobe, and identifi- cation and safeguarding of the ureteral orifices are discussed. RESULTS: There were no major perioperative or postoperative complications. Blood transfusions were not required. All patients were discharged on postoperative day one. CONCLUSIONS: Robot-assisted suprapubic prostatectomy may prove to be a feasible alternative in the management of large volume benign prostate glands. Further evaluation and assessment is required to evaluate the long-term clinical application of this technique. Source of Funding: None V1277 TECHNIQUE OF DELAYED DORSAL VEIN LIGATION AFFECTS APICAL MARGIN RATES DURING ROBOTIC RADICAL PROSTATECTOMY Ari Bergman*, Trushar Patel, William Berg, Ketan Badani, New York, NY INTRODUCTION AND OBJECTIVES: The prostatic apex is the most common location for positive surgical margins during robotic assisted laparoscopic prostatectomy. It has been surmised that this positive margin rate at the apical margin occurs during the release of the dorsal vein complex (DVC). We report our experience with two different techniques to ligate the DVC and subsequent positive margin rates at the apex. METHODS: A retrospective review of the Columbia Urologic Oncology database identified 118 patients who underwent standard DVC ligation (Group1) and 126 patients who had delayed DVC ligation (Group2) while undergoing RALP. Standard DVC ligation was defined as ligation of the DVC prior to the apical dissection, while delayed DVC ligation represented transection of the DVC prior to ligation and sub- sequently oversewn. Clinical and pathologic data was retrospectively evaluated and stratified by the type of DVC ligation done. Post-opera- tive continence was defined as 0 pads per day. RESULTS: Estimated blood loss (EBL) was similar between both standard and delayed DVC ligation, 188ml vs 126ml, respectively (p.05). Operative time was also similar, 132 minutes for Group 1 and 126 minutes for Group2 (p.05). Continence rates at 6 weeks and 3 months was 58% and 81% for patients with standard ligation and 56% and 84% for the delayed dissection group. There was a significant difference with respect to positive apical margins, the rate was 3.5% in patients with standard ligation vs. 1.2% in patients undergoing delayed ligation (p.05). Only one patient in Group1 needed a post ?operative transfusion. CONCLUSIONS: Delayed DVC ligation after apical dissection decreases positive margin rates at the apex during RALP. This tech- nique does not affect operative times, EBL, or post-operative conti- nence rate. This approach has become standard practice at our insti- tution. Source of Funding: None Bladder Cancer: Detection & Screening Moderated Poster Session 47 Monday, May 6, 2013 3:30 PM-5:30 PM 1278 NARROW BAND IMAGING IMPROVES THE DETECTION OF NEW AND RECURRENT BLADDER CANCERS AND CARCINOMA IN-SITU Wayne Lam*, Ben Ayres, Archana Fernando, Matthew Perry, London, United Kingdom INTRODUCTION AND OBJECTIVES: The current diagnostic and surveillance technique of choice for urothelial carcinoma (UC) of the bladder is white-light cystoscopy (WLC). However, small, flat or subtle papillary UC, as well as carcinoma in-situ (CIS), may be missed by WLC. Narrow band imaging (NBI) uses a narrow wavelength of light which is strongly absorbed by haemoglobin resulting in enhancement of epithelial surfaces and vascular architecture. At NBI cystoscopy e522 THE JOURNAL OF UROLOGY Vol. 189, No. 4S, Supplement, Monday, May 6, 2013