En Bloc TURBT Bernard Malavaud MD, PhD, FEBU Institut Universitaire - - PowerPoint PPT Presentation
En Bloc TURBT Bernard Malavaud MD, PhD, FEBU Institut Universitaire du Cancer Toulouse (France ) Is there anything as a standard TURBT ? Scooping away the luminal part of the growth ? Resecting the adherent part of the cancer ? What are the
Bernard Malavaud MD, PhD, FEBU Institut Universitaire du Cancer Toulouse (France)
Is there anything as a standard TURBT? Scooping away the luminal part of the growth ? Resecting the adherent part of the cancer ? What are the principles of BED - bladder endo- dissection ? Following the « holy plane of dissection « !
This is the story of a simple artisan’s pleasure in the actual style of performing an
precise manner. In developing these planes there are thus three basic principles: ( 1 ) Recognition of mobility between tissues of different
( 2 ) Sharp dissection under direct vision in a good light. ( 3 ) Gentle opening of the plane by continuous traction with no tearing.
Heald, Journal of the Royal Society of Medicine 1988
This is the story of a simple artisan’s pleasure in the actual style of performing an
precise manner. In developing these planes there are thus three basic principles: ( 1 ) Recognition of mobility between tissues of different
( 2 ) Sharp dissection under direct vision in a good light. ( 3 ) Gentle opening of the plane by continuous traction with no tearing.
Heald, Journal of the Royal Society of Medicine 1988
Get back to basic !
Mucosectomy Standard BED Agressive BED
The first strategic decision in Bladder Endo Dissection is to select the plane / depth of dissection by an initial nick in the bladder wall
Over distension = thin bladder wall = risk of perforation
Safety lines Obturator zone Critical zones
1.5 degree of freedom
Standard retrograde TURBT : Three degrees of freedom + sharp & blunt dissection Axial Transverse Coronal
which
Limited charring Margins evaluation Clean field en bloc surgery Optimal specimens for path analysis reduced ON stimulation taking full advantage of bipolar plasma kinetic dissection in saline
The perfect organization The perfect surgical management The perfect information on the cancer
Solid pathology report is at the foundation of modern management
A puzzling challenge for pathologists !
Bladder endoscopic dissection
a puzzling situation
Daniel et al., poster #660, session #49, EAU 2017 London
Brausi, Eur Urol 2002
Thank you most no limits to what we can achieve by prudent and well-thought blad