Bmz Hameed, Hegde Padmaraj, Shah Milap, Rai Bhavan Prasad, Thomas Joseph, Pai Kanthilatha, Naik Nithesh, Somani Bhaskar
Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India KMC Innovation Centre, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Ther Adv Urol. 2020 Nov 29;12:1756287220972230. doi: 10.1177/1756287220972230. eCollection 2020 Jan-Dec.
Transurethral resection of bladder tumour (TURBT) is the traditional technique of choice for endoscopically suspected bladder tumours. Cold En Bloc Excision (CEBE) using novel Zedd scissors is proposed for endoscopic treatment of patients with non-muscle invasive bladder cancer (NMIBC). The aim of this study was to evaluate feasibility and safety of CEBE of bladder tumours using Zedd scissors.
A pilot prospective study of patients who underwent a CEBE of suspicious bladder tumours using Zedd scissors was conducted. A total of 23 patients underwent CEBE for suspected bladder tumours using Zedd scissors. New and recurrent tumours <3 cm were included in the study. The outcome measures were the presence of detrusor muscle (DM) and obturator nerve reflex (ONR), bladder perforation rates, specimen cautery artefacts, recurrence rates and complication rates. The mean age was 64 years ± 10.41 (range: 49-83 years). The median follow up was 4 months (range 1-9 months). The mean tumour size was 1.8 cm ± 0.40 (range: 0.8-2.6 cm). Tumours were located in the lateral wall ( = 11), dome ( = 2), posterior wall ( = 6), trigone ( = 2), anterior wall ( = 4) and the junction of lateral and posterior wall ( = 4).
There was no ONR or bladder perforation and none of the patients had any complications. DM was present in 21 patients (91%). There was no tumour identified at the circumferential margins. There was no cautery artefact reported in any case. No patients had a recurrence at first follow up cystoscopy and two patients had out of field recurrence at subsequent cystoscopies.
CEBE with Zedd scissors is a promising en bloc excision technique for bladder tumour. It is a safe and feasible for excision of tumours less than 3 cm. The early oncological outcomes are comparable with existing en bloc resection techniques (ERBT) for NMIBC.
经尿道膀胱肿瘤切除术（TURBT）是内镜怀疑膀胱肿瘤时的传统首选技术。有人提出使用新型Zedd剪刀进行整块冷切除（CEBE），用于非肌层浸润性膀胱癌（NMIBC）患者的内镜治疗。本研究的目的是评估使用Zedd剪刀进行膀胱肿瘤CEBE的可行性和安全性。
对使用Zedd剪刀对可疑膀胱肿瘤进行CEBE的患者进行了一项前瞻性试点研究。共有23例患者使用Zedd剪刀对可疑膀胱肿瘤进行了CEBE。研究纳入了新发性和复发性肿瘤<3 cm的患者。观察指标包括逼尿肌（DM）和闭孔神经反射（ONR）的存在情况、膀胱穿孔率、标本烧灼伪像、复发率和并发症发生率。平均年龄为64岁±10.41（范围：49 - 83岁）。中位随访时间为4个月（范围1 - 9个月）。平均肿瘤大小为1.8 cm±0.40（范围：0.8 - 2.6 cm）。肿瘤位于侧壁（= 11例）、顶部（= 2例）、后壁（= 6例）、三角区（= 2例）、前壁（= 4例）以及侧壁与后壁交界处（= 4例）。
未出现ONR或膀胱穿孔，所有患者均未出现任何并发症。21例患者（91%）存在DM。切缘周围未发现肿瘤。所有病例均未报告烧灼伪像。首次随访膀胱镜检查时无患者复发，随后的膀胱镜检查中有2例患者出现视野外复发。
使用Zedd剪刀进行CEBE是一种有前景的膀胱肿瘤整块切除技术。对于切除小于3 cm的肿瘤是安全可行的。早期肿瘤学结果与现有的NMIBC整块切除技术（ERBT）相当。
