EN BLOC RESECTION OF BLADDER TUMOR(EBRT) USING MONOPOLAR CAUTERY; A TERTIARY HOSPITAL EXPERIENCE.

2021 ◽  
pp. 15-16
Author(s):  
Neeraj Agarwal ◽  
Bhuwan kumar ◽  
Prashant Gupta ◽  
Govind Sharma ◽  
Shivam Priyadarshi
Keyword(s):  
Bladder Cancer ◽  
Correct Diagnosis ◽  
En Bloc Resection ◽  
Tertiary Hospital ◽  
Complete Resection ◽  
High Rate ◽  
Severe Bleeding ◽  
Detrusor Muscle ◽  
Bladder Tumors ◽  
En Bloc

Bladder cancer is a growing health problem with the second most common urological malignancy. It accounts for around 7% of a new cancer diagnosis. Tobacco smoking is the most important risk factor accounting for around 50% of cases. Tobacco smokes contain aromatic amines and polycyclic hydrocarbons which are excreted through kidneys. The goal of transurethral biopsy in NMIBC(non-muscle invasive bladder cancer) is to make the correct diagnosis and completely remove all visible lesions which can be either resected piecemeal or en bloc. The presence of detrusor muscle in the specimen is an important factor for planning treatment and prognosis. Here we share our experience of EBRT using monopolar cautery describing the feasibility, safety, and adequacy of the procedure in the management of small urinary bladder tumors. The study was conducted in the Department of Urology, SMS Medical College, and attached hospitals. All the patients with clinical NMIBC during study duration were admitted and a total of 25 patients above the age of 18yrs, having papillary bladder tumors less than 3 cm were included in the study. Complete resection by the en bloc technique was achieved in all 25 cases with no requirement of conversion to conventional TURBT. Our study also shows the presence of detrusor muscle in 22 specimens out of 25. And only two patients developed severe bleeding which needed a blood transfusion. Thus, ERBT using monopolar cautery is safe and feasible for the complete resection of NMIBCs with a high rate of detrusor-positive specimens in the selected patient population.

scholarly journals Comparative analysis between En-bloc resection and transurethral resection of non-muscular invasive bladder tumors

2021 ◽  
Vol 64 (2) ◽  
pp. 65-69
Author(s):  
Ivan Vladanov ◽  
◽  
Alexei Plesacov ◽  
Vitalie Ghicavii ◽  
◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Bladder Tumor ◽  
Correct Diagnosis ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Detrusor Muscle ◽  
Bladder Tumors ◽  
En Bloc ◽  
Resection Group ◽  
Muscle Invasive

Background: Transurethral resection of the bladder (TURB) tumor was first described by Stern and McCarthy in 1931, and is still considered the gold standard in diagnosis and treatment of non-muscle-invasive bladder cancer. The quality of TURB affects accuracy of histopathologic evaluation, and subsequently impacts the risk of recurrence and patient outcome. New methods that aim to improve the effectiveness of TURB are reviewed, and recent studies are discussed, including resection methods and image enhancement techniques. Material and methods: Between January 2016 and April 2019, within the Urology Clinic of Nicolae Testemitanu State University of Medicine and Pharmacy 108 patients were surgically treated with bladder tumor pathology. Patients were divided in two groups: En-bloc resection group which includes 51 patients and transurethral resection group with 57 patients, the obtained data were comparatively analyzed. Results: Tumor analysis showed that the majority of the patients’ tumors were localized on lateral urinary bladder walls, single bladder tumors were detected in 64 (59%) cases, tumor sizes up to 3 cm were detected in 74 (69%) patients included in the study. Detrusor muscles were detected in 49 (96%) cases of En-bloc group and 45 (79%) cases of TURB group. Most recurrences occurred in patients with high-grade histological result, recurrence rate in En-bloc group occurred in 18% and in TURB group in 37%. Conclusions: The En-bloc resection technique of non-muscle-invasive bladder tumor proved to be a safe and effective method compared to the conventional transurethral resection technique (TURB). This method provides more favorable results for obtaining better quality tumor samples (present of detrusor muscle) that allow to establish correct diagnosis and staging of the disease and reduces the number of recurrences.

scholarly journals Endoscopic Submucosal Dissection of Papillary Gastric Adenocarcinoma; Systematic Review

2020 ◽  
Vol 9 (5) ◽  
pp. 1465
Author(s):  
Chang Seok Bang ◽  
Jae Jun Lee ◽  
Gwang Ho Baik
Keyword(s):  
Systematic Review ◽  
Endoscopic Submucosal Dissection ◽  
Curative Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Submucosal Invasion ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection

This study evaluated the possibility of endoscopic submucosal dissection (ESD) for early gastric cancer with papillary adenocarcinoma (EGC-PAC). PAC, an uncommon pathologic type of stomach cancer, is classified into differentiated-type histology. However, aggressive features, including a high rate of submucosal invasion, lymphovascular invasion (LVI), and lymph node metastasis (LNM), have been reported in studies with surgical specimens. Treatment outcomes of ESD for EGC-PAC have not been precisely demonstrated. Core databases were sought for the following inclusion criteria: studies of endoscopic resection or surgery of EGC-PAC presenting the following therapeutic indicators; en bloc resection, complete resection, curative resection, recurrence, complications associated with procedures, LVI, or LNM that enabled an analysis of ESD possibility. Overall, 15 studies were included for systematic review. Frequent submucosal invasion and high LVI were noted in EGC-PAC. However, PAC was not significantly associated with LNM. Pooled en bloc resection, complete resection, and curative resection rates were 89.7% (95% confidence interval: 55.3%–98.4%), 85.3% (67.7%–94.2%), and 67% (43%–84.5%), respectively. No LNM was observed if EGC-PAC satisfied the curative resection criteria. ESD seems technically feasible, although a high LVI rate results in a lower rate of curative resection.

scholarly journals Disección endoscópica con técnica de bolsillo submucoso. ¿Puede reemplazar a la disección convencional?

2021 ◽  
Vol 51 (3) ◽  
Author(s):  
Martín Yantorno ◽  
Gustavo Javier Correa ◽  
Sebastián Esteves ◽  
Florencia Giraudo ◽  
Agustina Redondo ◽  
...  
Keyword(s):  
High Risk ◽  
En Bloc Resection ◽  
Conventional Technique ◽  
Bloc Resection ◽  
Complete Resection ◽  
High Rate ◽  
Procedure Time ◽  
Technical Success ◽  
En Bloc

Endoscopic submucosal dissection is a complex technique that allows en bloc resection of large lesions. It is associated with long-term, technically complex procedures and a high risk of complications. The creation of a submucosal pocket is a variant of the conventional technique that reduces these difficulties, generating a high rate of complete resection with a shorter procedure time, a faster dissection speed and a lower rate of adverse events. Even though this variant was initially described in the stomach, its application has been generalized to other areas of the digestive tract. We present two cases where this variant technique was applied to treat large early lesions, with technical success.

Closed-loop audit of muscle sampling in Trans-Urethral Resection of Bladder Tumour

2021 ◽  
pp. 205141582110499
Author(s):  
Raghav Varma ◽  
Abdalla Deb ◽  
Dorina Roy ◽  
Ali Ahmed
Keyword(s):  
Bladder Cancer ◽  
Closed Loop ◽  
Bladder Tumour ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Detrusor Muscle ◽  
En Bloc ◽  
Level Of Evidence ◽  
Muscle Invasive

Introduction: Our experience with the presence of detrusor muscle (DM) following Trans-Urethral Resection of Bladder Tumour (TURBT). Objectives: To evaluate the presence of DM in primary TURBT specimens as a quality improvement exercise in Frimley Park Hospital, UK. And to assess if the level of the surgeon has impact on outcomes. Methods: Retrospective and prospective analysis of the electronic records from a single urology centre, servicing a group of urologists. Data collected over three consecutive audit loops between January 2014 and May 2018. Results: A total of 301 cases were performed under the care of seven consultant urologists. Analysis revealed a significant improvement in the overall quality of resections from 39% to 66% (50–84% for intermediate and high grade) after the introduction of the following interventions: (1) analysis and improved awareness of current practice; (2) introduction of European Association of Urology (EAU) guidelines by separating samples and sending a second specimen pot marked as bladder tumour base to look for DM; (3) dedicated urologists with an interest in bladder cancer performing en-bloc resection technique in appropriate cases. Conclusion: Through our closed-loop audits, we have demonstrated a considerable improvement in the quality of resections, resulting in accurate staging from the initial resection. This could in turn lead to improved over all prognoses and negating the need for re-resection in all cases of high-risk non-muscle invasive bladder cancer (NMIBC). Level of evidence: 3

Laser versus electrical en bloc resection of bladder tumors: Results of a European multicenter study (EBRUC).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 310-310
Author(s):  
Mario W. Kramer ◽  
Alexey Martov ◽  
Nikolay Baykov ◽  
Jan Klein ◽  
Jens J. Rassweiler ◽  
...  
Keyword(s):  
Laser Energy ◽  
Postoperative Bleeding ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Detrusor Muscle ◽  
Bladder Tumors ◽  
Recurrence Rates ◽  
En Bloc ◽  
Muscle Involvement ◽  
Perioperative Morbidity

310 Background: The quality of transurethral resection of bladder tumors strongly determines patient’s tumor after-care and prognosis. En bloc resection of bladder tumors (ERBT) might improve staging quality, perioperative morbidity and influence tumor recurrence. This is the first European multi-center study which was initiated by ESUT and was conducted to evaluate the safety, efficacy and recurrence rates of electrical vs. laser ERBT. Methods: Transurethral ERBT was performed on 221 prospectively collected patients in six academic centers with either monopolar/bipolar current or holmium/thulium laser energy. Staging quality measured by detrusor muscle involvement, various perioperative/surgical parameters and 12 months follow-up data were analyzed. Results: 156 and 65 patients were treated with electrical and laser ERBT, respectively. Median tumor size was 2.1 cm with biggest up to 5 cm. Detrusor muscle was available in 97.3%. A switch to conventional TURBT was significantly more frequent in the electrical ERBT group (26.3% vs. 1.5%, p<0.001). Median operation duration (25 min), postoperative irrigation (1 day) and catheterization time (2 days) as well as hospitalization (3 days) were similar in both groups. Overall complication rate was low (Clavien ≥3, n=6 (2.7%)). Hemoglobin was significantly more decreased after electrical ERBT (p=0.0013), however overall hemoglobin loss was not clinically relevant (0.38 g/dl). 148 patients with first diagnosis of urothelium carcinoma of the bladder were followed for 12 months of which 33 (22.3%) recurred. 63.6% of recurrences occurred out of the ERBT resection field. No difference was noticed between both ERBT groups. Conclusions: ERBT is safe and reliable regardless of the energy source used and offers high quality resections of tumors >1 cm. Recurrence rates did not differ within both groups although the majority of recurrences were noticed out of the ERBT resection field. Laser device might be an alternative for the treatment of patients with higher risk of postoperative bleeding due to its efficient hemostatic effect.

scholarly journals En Bloc Resection of Bladder Tumor—Is It the Way Forward?

2021 ◽  
Vol 8 ◽  
Author(s):  
Christian Daniel Fankhauser ◽  
Marian Severin Wettstein ◽  
Luca Afferi ◽  
Nico Christian Grossmann ◽  
Hugh Mostafid
Keyword(s):  
Bladder Cancer ◽  
Cancer Patients ◽  
Transurethral Resection ◽  
Bladder Tumor ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
80 And Over ◽  
Bladder Tumors ◽  
En Bloc ◽  
Translational Studies

Transurethral resection of bladder tumors (TURBT) represents the cornerstone in diagnosis and treatment of bladder cancer but recurrence is observed in up to 80% and over- or understaging with TURBT is common. A more recent development to overcome these limitations represents en-bloc resection of bladder tumors (ERBT) which offers several advantages over TURBT. In this report, we briefly review studies assessing outcomes of bladder cancer patients undergoing ERBT. Most randomized and non-randomized trial demonstrate improvement in clinical outcomes for ERBT over TURBT, however more pathological and translational studies are warranted.

scholarly journals Feasibility of Endoscopic Submucosal Dissection: A New Technique for En Bloc Resection of a Large Superficial Tumor in the Colon and Rectum

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
T. Shono ◽  
K. Ishikawa ◽  
Y. Ochiai ◽  
M. Nakao ◽  
O. Togawa ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
High Rate ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Colon And Rectum ◽  
A New Technique ◽  
Average Procedure Time

Endoscopic submucosal dissection (ESD) is a promising procedure that enables en bloc resection of large superficial tumors in the upper gastrointestinal tract. On the other hand, ESD in the colon and rectum is technically difficult to perform because of its anatomical features. At our institution, 137 consecutive superficial colorectal tumors larger than 20 mm in diameter in 137 patients were treated by ESD between April 2007 and October 2010, and 132 lesions were successfully resected. The average procedure time was 79.2 minutes, and the rate of en bloc resection was 89.1% (122/137). The rate of complete resection, defined as en bloc resection with tumor-free lateral and vertical margins, was 85.4% (117/137). The rate of perforation was 3.6% (5/137). Colorectal ESD achieved a high rate of en bloc resection and complete resection and is applicable in the colorectum.

scholarly journals Endourological treatment of non-muscular-invasive bladder tumors

2021 ◽  
Vol 64 (5) ◽  
pp. 33-37
Author(s):  
Ivan Vladanov ◽  
Keyword(s):  
Transurethral Resection ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Characteristic Size ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bladder Tumors ◽  
En Bloc ◽  
Size Number ◽  
Different Types

Background: Transurethral resection of the bladder is one of the essential methods in the diagnosis, treatment and management of non-muscularinvasive bladder cancer. The purpose of the procedure is to remove completely all visually detected tumors with a following establishment of a very precise histological diagnosis. The aim of the study is to compare the results of conventional transurethral endoscopic treatment and the En-bloc resection method using different types of energy sources in the treatment of bladder tumors. Material and methods: A total number of 88 patients underwent endourological interventions. Regarding the distribution, 23 patients had conventional transurethral resection, 22 – En-bloc monopolar resection, 21 – En-bloc bipolar resection and 22 – En-bloc with Thu:YAG laser. Clinical data, intraoperative and postoperative data and also the histopathological examination results were compared. Results: The compared groups were heterogeneous by age, sex, tumor characteristic (size, number, location). No significant differences were observed during the operations, comparing the intraoperative and postoperative complications of the studied groups. The detrusor musculature was detected in 74% of cases after conventional transurethral resection, in 91% of cases of En-bloc monopolar resection, in 95% of cases of En-bloc bipolar resection and in 96% of cases of En-bloc Thu:YAG laser. Conclusions: The En-bloc resection technique of non-muscular-invasive bladder tumors is a safe and effective method comparing with the conventional transurethral resection; it allows more favorable postoperative results and obtaining better quality tumor samples which allow establishing correct diagnosis of the disease.

Sign in / Sign up

Export Citation Format

Share Document