En bloc transurethral resection of bladder tumor with Collins loop: our experience
Abstract
The main limitation of standard transurethral resection (TUR) of bladder cancer is fragmentation of the speciment which may impair the pathological analysis. The en bloc TURBT overcomes this problem.
Tecnique
Apart from the standard equipment (ESG 400 scalpels, , optical 0° for uretroscopy and 30° for TURBT), our technique requires a 12° with Collins loop for en bloc TURBT.
The bladder wall is incised around the lesion using a Collins loop (with a cutting current), starting from ‘normal’ mucosa surrounding the base and then extending through the subepithelial connective tissue and muscularis propria strata, inclining the loop to avoid any serious perforation. After the lesion has been detached from the bladder, the tumour is grasped by the loop and taken out under vision. Each specimen is macroscopically orientated and examined to assess its greatest dimension and the lateral circumferential margins. Staging is done in accordance with TNM classification and grading by the WHO 2004 classification.
Margins and bottom are resected with a classic loop and NBI assisted repeat TURBT
Conclusion
In our experience en bloc bipolar TURBT with Collins loop is a feasible and safe tecnique.