Pneumocystoscopic accurate transurethral resection of bladder tumor
SUN Shenkun1,2, SHAN Lisong2, Xu Yong1, FU Weijun1, ZHANG Xu1
1Department of Urology, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; 2Department of Urology, Hainan Hospital of PLA General Hospital
Abstract：Objective： To investigate the feasibility and efficacy of transurethral en bloc resection of bladder tumor in the condition of carbon dioxide pneumocystoscopy. Methods： The patient was placed in the lithotomy position under general anesthesia, and the bladder pressure of carbon dioxide was set as 11 mmHg. Cystoscopy was first performed. Accurate transurethral resection of bladder tumor was performed by using a monopolar needle electrode. The normal bladder mucosa was electrocauterized circularly 0.5 cm away from the edge of the tumor. Then the needle was inserted into the bladder wall to pull the tissue towards the midline, followed by cutting with an electrical cutting current. Sharp and blunt separations were performed along the base of the tumor until the entire tumor was completely removed. A tumor trapper was used to extract the tumor en bloc through the sheath of the resectoscope. The patient received continuous bladder irrigation with saline solution after catheter indwelling. Immediate intravesical chemotherapy was carried out by instillation of pirobicin hydrochloride within 24 h after surgery. Results： The tumor nested in the left side wall of the bladder near the ureteral orifice. En bloc resection of the tumor was achieved by the monopolar needle electrode with CO2 insufflation. Intraoperative arterial blood gas analysis showed normal pressure of CO2. No obturator nerve reflex or bleeding occurred. The operation time was 15 min and the tumor was extracted en bloc. The tumor was 1.5 cm in diameter and pathologic report showed low grade urothelial carcinoma of the bladder, with a negative margin. No invasion of the muscular layer was observed. The catheter was removed 2 days post-operation. Cystoscopy 3 months after operation showed a well healing of the tumor bed in the bladder, and no tumor recurrence was found during one-year follow-up period after the operation. Conclusions： En bloc tumor resection can be achieved with a needle electrode under CO2 pneumocystoscope. This novel technique has advantages including en bloc tumor resection and extraction, less flushing fluid used, and without consideration of urine extravasation, obturator nerve reflexion, bleeding, or tumor spreading during operation.
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