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 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 operation - in essence the way to use a pair of scissors to define and develop a plane in a precise manner . In developing these planes there are thus three basic principles : ) ( 1 Recognition of mobility between tissues of different origins . ) ( Sharp dissection under direct vision in a good light . 2 ) ( Gentle opening of the plane by continuous traction with no tearing . 3 Heald, Journal of the Royal Society of Medicine 1988
Get back to basic ! This is the story of a simple artisan’s pleasure in the actual style of performing an operation - in essence the way to use a pair of scissors to define and develop a plane in a precise manner . In developing these planes there are thus three basic principles : ) ( 1 Recognition of mobility between tissues of different origins . ) ( Sharp dissection under direct vision in a good light . 2 ) ( Gentle opening of the plane by continuous traction with no tearing . 3 Heald, Journal of the Royal Society of Medicine 1988
The first strategic decision in Bladder Endo Dissection is to select the plane / depth of dissection by an initial nick in the bladder wall Mucosectomy Standard BED Agressive BED
Over distension = thin bladder wall = risk of perforation
Critical zones Obturator zone Safety lines
Standard retrograde TURBT : 1.5 degree of freedom Three degrees of freedom + sharp & blunt dissection Axial Transverse Coronal
which
en bloc reduced ON surgery stimulation Limited charring Clean field taking full advantage of bipolar plasma kinetic dissection in saline Optimal specimens Margins for path analysis evaluation
The perfect organization The perfect surgical management The perfect information on the cancer
Solid pathology report is at the foundation of modern management 1. Primary vs. recurrence 2. T Stage 3. Grade 4. Number of lesions 5. Size 6. Carcinoma in situ
A puzzling challenge for pathologists !
Bladder endoscopic dissection offers a structured response to a puzzling situation
Daniel et al., poster #660, session #49, EAU 2017 London
Brausi, Eur Urol 2002
Forget En Bloc TURBT … move to Bladder Endo Dissection
most no limits to what we can achieve by prudent and well-thought blad Thank you
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