Name:
Transurethral resection of bladder tumor
Description:
Transurethral resection of bladder tumor
Thumbnail URL:
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Duration:
T00H11M11S
Embed URL:
https://stream.cadmore.media/player/fb7752ae-050d-4d0f-b301-4c931b90ff4f
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/fb7752ae-050d-4d0f-b301-4c931b90ff4f/Transurethral resection of bladder tumor.mp4?sv=2019-02-02&sr=c&sig=3DIdyXnBFqynVtS4EZPBGdwToFJ1zB%2FvXpM3ypCw7N8%3D&st=2026-05-23T04%3A39%3A10Z&se=2026-05-23T06%3A44%3A10Z&sp=r
Upload Date:
2023-10-19T00:00:00.0000000
Transcript:
Language: EN.
Segment:1 PREOPERATIVE POSITION.
SPEAKER 1: Preoperative position. [MUSIC PLAYING]
SPEAKER 2: The patient is placed in lothotomy position in our operating room. Endoscopic tower is usually positioned on the right side, such as the table with all the endoscopic equipment. Gravity fluid irrigation system and power generator are placed on the left side.
SPEAKER 1: Otis urethrotome.
Segment:2 OTIS.
SPEAKER 1: The Otis urethrotome set includes the dilator apparatus, the blade, a conical tip, a flat tip, and a ball tip to accommodate a wide range of cases. Otis urethrotome should be always available to treat patients with penile urethral stricture. Here, we show how it should be performed.
Segment:3 URETHROCYSTOSCOPY.
SPEAKER 1: Urethrocystoscopy. First step of urethrocystoscopy is to inflate a jelly solution in the urethra to minimize urethral stress and damages. Introduction of the resectoscope should be performed under vision in order to visualize the whole urethra, which could be interested by urothelial tumor.
SPEAKER 1: At the level of the verumontanum, you should bend the stretched penis towards the operator to allow the passage of the instrument. Once at the level of the bladder neck, you can start your bladder inspection. First step of cystoscopy is to identify urethral meatus bilaterally.
SPEAKER 1: Inspection of the whole bladder mucosa should be performed. We start from the posterior wall where it is possible to appreciate a 5 millimeters papillary tumor. Inspection of the dome and anterior wall should be performed, rotating the instrument of 180 degrees, and pushing with operator's left hand on the lower abdominal wall of the patient. You can recognize a 1-centimeter papillary tumor at this level.
SPEAKER 1: To complete the cystoscopy, lateral walls should be also explored so to define number, size, focality, microscopic appearance, and location of the tumors. Resection steps.
Segment:4 RESECTION STEPS.
SPEAKER 1: A big bladder tumor is located at the level of bladder neck. The appearance is one of a polypoid mass bigger than 3 centimeters. After full identification of the tumor, we can start the resection of the mass.
SPEAKER 1: The area to resect should be divided in sectors, and each sector should be completed before moving on the next. Hemostasis should be achieved at the tumor base before moving to the next sector.
Segment:5 LATERAL WALL RESECTION.
SPEAKER 1: Lateral wall resection. Resection on the lateral well should be carried with resection loop positioned parallel to the mucosa in order to use its edge, and avoid deep perforation in case of spasm. Resection of tumor base after resection of exophytic carrier is completed.
SPEAKER 1: Additional deep and marginal specimens should be taken and separately sent for pathology.
Segment:6 SPASM OF THE OBTURATORY NERVE.
SPEAKER 1: Spasm of the obturatory nerve. When resecting on the lateral wall, be aware of possible obturatory nerve stimulation, which leads to a doctor's muscle spasm and bladder wall movement, causing accidental bladder perforation.
Segment:7 DOME TURBT.
SPEAKER 1: Dome TURBT. Resection on the bladder dome can be tricky because of the risk of intraperitoneal perforation. Resection can be performed using left hand to push above the lower abdomen, obtaining lowering of the bladder dome, an easier approach to it. The area to resect should be always divided in sectors, and each one should be completed before moving on to the next sector.
SPEAKER 1: Resection should start from the upper part of the tumor and move down to the tumor base. Hemostasis should be achieved at the tumor base and at the edges of resection.
Segment:8 HEMOSTASIS.
SPEAKER 1: Hemostasis. Hemostasis should be achieved by targeted electrocauterization of visible bleeding vessels.
SPEAKER 1:
Segment:9 BLADDER PERFORATION.
SPEAKER 1: Bladder perforation.
SPEAKER 1: Bladder perforation might accidentally occur during tub. When perforation is extraperitoneal, we suggest a complete tumor resection, and achieve hemostasis quickly, keeping low intravascular pressure in order to reduce fluid extravasation and self-seading.
SPEAKER 1: Bipolar en bloc TURBT.
Segment:10 BIPOLAR EN BLOC TURBT.
SPEAKER 1: A standard urethrocystoscopy is the first step. After urethral orifice identification, a superficial and circumferential incision of the mucosa with a 5-millimeter safety margin of normal appearing tissue is carried out. During resection, bleeding vessels are punctually coagulated.
SPEAKER 1: Once the mucosa is incised, the resection proceeds deep to the detrusor, resecting from the periphery to the tumor base, using the blunt dissection of the resectoscope tip and of the irrigation that help in uplifting the lesion. The detrusor layer should be reached at the beginning of the dissection, which should carry on along the muscular plane from the periphery to the center of the tumor base.
SPEAKER 1: The resection should be performed filling the bladder to a medium capacity to avoid overstretching of tissue which could make it difficult to identify the dissection plane.
SPEAKER 1: Once the tumor has been detached from the bladder wall, additional resection or biopsies of tumor base can be performed and sent for histological assessments separately if the surgeon has any doubt of tumor left in the site of resection.
Segment:11 THULLIUM LASER EN BLOC ENUCLEATION....
SPEAKER 1: Thullium laser en bloc enucleation of bladder tumor. A superficial and circumferential incision of the mucosa with a 5 millimeters safety margin of normal appearing tissue is carried out all around the lesion.
SPEAKER 1: After the incision of the mucosal layer, the laser is used to progressively current down to the base of tumor exposing the detrusorial muscle fiber and using the irrigation to uplifting the lesion.
SPEAKER 1: After the tumor enucleation, a point-specific hemostasis is performed.
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