Design of a novel instrument for cold excision of bladder tumors under local anesthesia

Abstract Objective: To design a new cold dissection instrument for bladder tumors that can be used under local anesthesia without the need for general or intralesional anesthesia. The instrument will be used for cold dissection of bladder tumors based on the existing cystoscopy routine operation channel. The device will be combined with the cocktail protocol to accomplish cold resection of bladder tumors under local anesthesia METHODS: 3-dmax mapping was used to design the instrument by combining the existing Endoscopic Submucosal Dissection technique in gastroenterology with the existing bladder injection needle and bipolar electrocoagulation equipment in the clinic. We also assessed the effect of "cocktail" anesthesia on the prevention of closed nerve reflex during tumor resection. RESULTS: The prototype this device was successfully designed using 3dmax. We then assessed if the injection needle, electrocoagulator, and ligature ring commonly used in clinical practice can be used in combination based on the existing cystoscopic access，The existing instruments used in the department of gastroenterology can complete the functions we imagined, and the physical size can meet the requirements of the existing cystoscope endoscope channel. We also demonstrated that the cocktail protocol was successfully in preventing the occurrence of Obturator reflex of bladder lateral wall tumor. CONCLUSION: The instrument was successfully developed and used for cold excision of bladder tumors in combination with the cocktail protocol. This instrument has wide clinical utility as its use can be extended to all scenarios requiring endoscopic resection, including gastroscopy.