Surgical technique for en bloc transurethral resection of bladder tumor with a Hybrid Knife®

Abstract

BackgroundBladder cancer is the second most common malignancy of the urinary tract and the 9th worldwide. Latin American has an incidence of 5.6 per 100,000 inhabitants per year. Seventy-five percent of newly diagnosed cases are nonmuscle invasive bladder cancer, and 25% of cases present as muscle invasive. The mainstay of treatment for nonmuscle invasive bladder cancer is loop transurethral resection. In 2013, the group led by Dr Mundhenk of the University Hospital of Tübingen, Germany, was the first to describe the Hybrid Knife® equipment for performing en bloc bladder tumor resection, with favorable functional and oncological results. ObjectiveTo describe the surgical technique of en bloc bladder tumor resection with a Hybrid Knife® as an alternative treatment for nonmuscle invasive bladder tumors. Material and methodsA male patient was diagnosed by urotomography and urethrocystoscopy with a bladder tumor measuring 2×1cm on the floor. En bloc transurethral resection of the bladder tumor was performed with a Hybrid Knife®. ResultsSurgery was performed for 35min, with 70W for cutting and 50W for coagulation, resecting and evacuating en bloc the bladder tumor, which macroscopically included the muscle layer of the bladder. There were no complications. ConclusionThe technique of en bloc bladder tumor resection with Hybrid Knife® is an effective alternative to bipolar loop transurethral resection. Resection with a Hybrid Knife® is a procedure with little bleeding and good surgical vision and minimizes the risk of bladder perforation and tumor implants. The procedure facilitates determining the positivity of the neoplastic process, vascular infiltration and bladder muscle invasion in the histopathology study.