Category: Laparoscopy: Lower Tract - Malignant
Introduction & Objective :
Screening and diagnosing allowed for earlier detection of bladder cancers (Tis-T1N0M0). These tumors can be resected endoscopically, and while transurethral resection of bladder tumor leads to scattering of cells and thermal damage to the specimen, laser en-bloc resection enables complete cancer removal, avoiding complications and obtaining the best samples for histopathology.
Sixty-nine patients (46 males and 23 females) aged 60.1 (22-81) years with bladder tumor (Ta, Tis, T1N0M0) underwent PDD-assisted thulium fiber (Tm-fiber) laser en-bloc resection of bladder tumor. A total of 79 en-bloc enucleations were performed. Tumor size ranged from 0.5 to 6 cm. For enucleation, we used Urolase (NTO IRE-POLUS, Russia), a 120 W thulium fiber laser, and a 600 µm fiber. The EORTC bladder calculator was used for risk assessment. In 60 cases it was intermediate and in 9 cases – high. Follow-up lasted for 6-12 months.
Mean surgery time was 43.4 min. All surgeries were uneventful with no cases of intraoperative bladder damage. Following surgery, all the patients underwent 1 hour long intravesical therapy with 40 mg of Mitomycin C. In 75 (94.9%) cases, histopathology revealed muscle tissue. Mean catheterization time was 22.5 hours. Mean hospital stay was 2.9 days. No postoperative complications exceeding grade I on the Clavien-Dindo scale were observed. In 12 months after surgery, relapse was noted in 8 (11.6%) patients.
Tm-fiber laser en-bloc resection of bladder tumors with PDD is a safe treatment option for early-stage prostate cancer (Ta, Tis, T1N0M0). PDD allows for better control over the surgery site ultimately decreasing the risk of relapse. The technique offers a possibility of obtaining better samples for subsequent histopathology thus giving the option of adjusting personalized treatment in each case of bladder cancer.
Dmitry Enikeev– Deputy Director for Science, Institute for Urology and Reproductive health, Sechenov University, Moscow, Moskva, Russia
Leonid Rapoport– Deputy Director, RI for Uronephrology, Sechenov University, Moscow, Moskva, Russia
Mark Taratkin– Researcher, Institute for Urology, Sechenov University, Moscow, Moskva, Russia
Deputy Director for Science
Institute for Urology and Reproductive health, Sechenov University
Moscow, Moskva, Russia
Experienced in TURP (>300 surgeries).
Experienced in upper urinary tract endosurgery (PCNL >200, RIRS >200).
2008-Present: Multiple upper and lower urinary tract surgeries;
2011-Present: HoLEP (400 surgeries);
2011-Present: En-bloc enucleation of bladder tumor (50 surgeries);
2016-Present: ThuLEP (>400 surgeries);
2016-Present: Thulium en-bloc enucleation of bladder tumor (>80 surgeries);
2016-Present: Brachytherapy (>40 surgeries); prostate cryoablation (70 surgeries), renal cancer cryoablation (30 surgeries);
Apr 2017-Present: Irreversible electroporation (10 surgeries);
Apr 2017-Present: MR-fusion prostate biopsy (80 procedures).
RI for Uronephrology, Sechenov University
Moscow, Moskva, Russia