Technical Considerations for Bipolar Enbloc Resection of Bladder Tumors

Introduction: Transurethral resection of bladder tumor (TURBT) is important for treatment, staging, and prognostication of bladder cancer. Conventional TURBT comprises piecemeal resection of the lesion, followed by separate resection of tumor base. Enbloc TURBT is a technique wherein the tumor is resected as a whole. It is associated with better pathologic assessment of tumor stage and grade,1 and has reasonable perioperative and short-term oncologic outcomes.2 In this video, we demonstrate the technical considerations for enbloc resection of bladder tumors. Materials and Methods: Between July 2019 and August 2020, all patients who underwent enbloc resection were identified from a prospective data set. Clinical variables of demographics, tumor size and grade, pathologic stage, and perioperative outcomes were analyzed. Results: There were 13 patients with 20 bladder tumors and operated by 2 surgeons. Median age was 74 years (range 61–87), and comprised eight male patients (62%). The median size of the bladder tumors was 1.5 cm (range 1–4 cm), and mostly located at the lateral wall (n = 13). Four (20%), two (10%), and one (5%) tumors were located at the anterior wall or dome, posterior wall, and trigone or bladder neck, respectively. Most tumors were stage Ta (75%). Four tumors were T1 high grade (20%) and one tumor was T2 high grade (5%). There were n = 3 patients with prior TURBT who underwent enbloc resection. Detrusor muscle was consistently present in the resected TURBT specimens after a learning curve of four patients. No intraoperative bladder perforations occurred. Ten (77%) patients received postoperative intravesical mitomycin C within 24 hours of surgery, and all patients had their urinary catheters removed by postoperative day 1. Conclusion: Enbloc TURBT is safe, reproducible, and enhances accurate histologic staging. It is applicable in both primary and repeated resections. In larger tumors, it facilitates early identification of feeding blood vessels and enhances surgical hemostasis. No competing financial interests exist. Runtime of video: 7 mins 26 secs