Treatment of Nonmuscle Invasive Bladder Cancer Using a Novel Zedd Scissors

Abstract

Introduction:

Treatment of nonmuscle invasive bladder cancer (NMIBC) usually requires piecemeal resection of the tumor. En bloc resection emerges as a promising technique for small bladder tumors <3 cm. The completeness of resection is defined by the presence of the detrusor muscle (DM) in the specimen. Contrary to the advantages of en bloc resection, there are several drawbacks of electrocautery for the resection of tumor. These include absence of DM, presence of obturator jerk because of dissipation of heat, perforation of bladder, and charring of the specimen. We share our experience of cold en bloc excision (CEBE) technique for nonmuscle invasive bladder tumor using the novel Zedd scissors.

Methods and Materials:

This was a single center prospective study carried out at department of urology at Kasturba Medical College, Manipal, India, from July 2019 to October 2019. Patient consent was obtained and a total of 12 patients were included in the study who had pedunculated tumors of size ≤3 cm, and up to three lesions in total. Any patient with endoscopic suspicion of carcinoma in situ, upper tract transitional cell carcinoma, broad base tumors >3 cm, and more than three tumors was excluded from the study. A novel Zedd scissors that could be passed through the working channel of 20.8F mini nephroscope was used for CEBE of the tumors with minimal use of electrocautery to coagulate the bladder base. The excised specimen was sent for histopathologic examination and patients were followed up at 3 months with check cystoscopy.

Results:

A total of 12 patients underwent CEBE using the Zedd scissors. The mean size was 1.6 cm (range: 1–2.6 cm). The mean excision time was 4 min 26 sec. None of the patients had obturator jerk or bladder perforation. There was no significant drop in hemoglobin in the postoperative period. Patients were discharged after 48 hr of the procedure. The histopathologic findings were T1 (n = 7), Ta (n = 4), and T2 (n = 1). Ten patients had presence of DM in the specimen. Follow-up at 3 months with cystoscopy did not show any recurrence.

Conclusion:

CEBE using Zedd scissors is safe and efficacious with confirmed presence of DM in the specimen. It avoids charring of the tissues, and the risk of perforation because of obturator jerk is almost negligible. It is also an economical alternative to various other modalities used for resection of NMIBC.

No competing financial interests exist.

Runtime of video: 9 mins 35 secs