V1855 EN-BLOC RESECTION OF NON-MUSCLE INVASIVE BLADDER TUMORS WITH A NOVEL HYBRID INSTRUMENT (HYBRIDKNIFE®)
2013-03-27

You have accessJournal of UrologyBladder Oncology1 Apr 2013V1855 EN-BLOC RESECTION OF NON-MUSCLE INVASIVE BLADDER TUMORS WITH A NOVEL HYBRID INSTRUMENT (HYBRIDKNIFE®) Jens Mundhenk, Saladin Alloussi, Florian Miller, Georgios Gakis, David Schilling, Arnulf Stenzl, and Christian Schwentner Jens MundhenkJens Mundhenk Tuebingen, Germany , Saladin AlloussiSaladin Alloussi Neunkirchen, Germany , Florian MillerFlorian Miller Tuebingen, Germany , Georgios GakisGeorgios Gakis Tuebingen, Germany , David SchillingDavid Schilling Frankfurt, Germany , Arnulf StenzlArnulf Stenzl Tuebingen, Germany , and Christian SchwentnerChristian Schwentner Tuebingen, Germany View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2274AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer represents the most frequent malignancy of the urinary tract. Global Cancer Statistics report a yearly incidence of 330,000 people diagnosed with bladder cancer and a total mortality of over 130,000 patients. Approximately 75-85 % of patients present with non-muscle invasive tumor stages. With conventional transurethral resection (TUR-BT) the oncological principle of en-bloc resection cannot be accomplished in the majority of bladder tumors. Due to limitations of the resection loop, the tumor can only be resected in several fractions, in a so-called piecemeal technique. The en-bloc resection of gastro-intestinal tumors, known as endoscopic submucosal dissection (ESD), is well established and has led to lower recurrence rates. METHODS We used the combination instrument HybridKnife® (HK) for transurethral en-bloc resection (TUEB-RT) in analogy to ESD. The probe has a diameter of 7F and consists of a high-frequency electrode at the distal end whose hollow shaft is also used as a waterjet nozzle. The resection area was marked with punctiform coagulations and a water cushion was created underneath the tumor. The water cushion was created by the densely focused waterjet penetrating the bladder mucosa and forming a spacer in the subepithelial layer. Afterwards the mucosa was incised and the tumour undermined and excised. After extensive training with animal models we used this technique as a pilot study to determine patients' safety, technical feasibility and quality of pathological specimen. Complications were reported using the modified Clavien-Dindo classification. RESULTS We performed TUEB-RT in 16 patients with the HK. 15 patients were solely operated with the HK, in 1 patient the procedure was finished using conventional TUR-BT. Mean resection time per lesion was 27 minutes (range 15-35 minutes). No major complications (>Clavien °II) nor a significant drop in hemoglobin (>1g/dl) was observed. Postoperative irrigation was stopped on the day of surgery in all patients. Pathology revealed 4 benign results, 3 Cis, 7 pTa, 2 pT1 and 1 pT2a tumors. Even in cases of accidental obturator stimulation handling was safely possible in all patients with a low risk of perforation. CONCLUSIONS TUEB-RT was feasible and reproducible in all cases. The technique is a promising attempt to implement oncological principles of tumor resection into endo-urological treatment of bladder tumors. A prospective randomized multicentre study to evaluate the applicability as well as the functional and oncological outcome was initiated in September 2012. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e761-e762 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jens Mundhenk Tuebingen, Germany More articles by this author Saladin Alloussi Neunkirchen, Germany More articles by this author Florian Miller Tuebingen, Germany More articles by this author Georgios Gakis Tuebingen, Germany More articles by this author David Schilling Frankfurt, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...