Prospective evaluation of plasma kinetic bipolar resection of bladder cancer: comparison to monopolar resection and pathologic findings

Abstract

Objective To determine whether the Gyrus ACMI plasma kinetic bipolar device (Gyrus ACMI, Southborough, MA) improves pathologic specimen preservation and clinical outcomes compared to standard monopolar electrocautery. Patients and methods In our prospective study, 83 patients underwent monopolar or bipolar transurethral resection of bladder tumors between April 2006 and February 2007 at Memorial Sloan-Kettering Cancer Center. Dedicated genitourinary oncology pathologists blinded to resection type and assessed pathologic features including stage and grade, presence of muscularis propria, fragment size, presence and thickness of thermal artifacts within the specimen, layer of tissue most affected, severity of tissue distortion, and diagnostic impact of thermal artifacts. Clinical outcomes including, perforation, obturator reflex, need for muscle paralysis, a catheter, or admission, were recorded. Clinical and pathologic outcomes between resection modality were compared. Results There were no significant thermal artifacts in 9/38 (23.7 %) and 11/45 (24.4 %) monopolar and bipolar specimens, respectively. The layer of bladder tissue most affected by thermal artifacts was readable in 18/38 (47.4 %) monopolar and 27/45 (60.0 %) bipolar specimens. Tissue distortion from thermal artifacts led to areas within 11/38 (28.9 %) monopolar and 7/45 (15.6 %) bipolar specimens being unreadable. Ultimately, thermal artifacts caused moderate diagnostic difficulty in 2/38 (5.3 %) specimens of the monopolar group and severe diagnostic difficulty in 1/45 (2.2 %) bipolar specimens. Clinically, there was no major difference between resection methods. Conclusion Plasma kinetic bipolar equipment appears to cause less tissue distortion and has the potential to facilitate staging and grading of bladder tumors. No differences in clinical outcomes were appreciated between resection methods. If these results can be repeated in larger studies, the bipolar device represents a small advancement in transurethral resection.

Bipolar Versus Monopolar Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: A Meta-Analysis

“…The procedures of TURB were not performed in the same way in different countries. For example, in some countries like USA, most TURBs are outpatient 13 , where the problem of hospital stay does not exist. However, postoperative rehabilitations in hospital are needed in many places with underdeveloped domestic medicine, and the shorter hospital stay in bTURB group would be significant.…”

“…221 records were retrieved through database searching, after screening eight trials [8][9][10][11][12][13][14][15] were selected in our meta-analysis, (Fig.1) including 490 patients undergoing bTURB and 500 patients undergoing mTURB respectively. Six studies were RCTs, one study was prospective case-control study, and the other one was retrospective case-control study.…”

“…Additionally, bipolar TURB (bTURB) was also expected to present some advantages compared with monopolar TURB (mTURB) for the treatment of NMIBC 6,7 . In recent years, a number of studies have begun to compare the safety and efficacy between bTURB and mTURB [8][9][10][11][12][13][14][15][16][17] , but it is difficult to detect low incidence events based on a single trial. Thus, we conducted a meta-analysis of the literatures on the feasibilities and advantages of bTURB versus mTURB in terms of demographic and clinical baseline characteristics, perioperative and postoperative variables.…”

Can bipolar energy serve as an alternative to monopolar energy in the management of large bladder tumours >3 cm? A prospective randomised study

“…Hashad et al [20] also reported bladder perforation in four patients in their monopolar arm and in one patient in the bipolar arm, with no statistical difference between the groups (P = 0.369). Mashni et al [21] reported that no patients developed bladder perforation, with no statistically difference between the groups. Also Liem et al [5] reported no statistically difference between the groups.…”

Comparison of Monopolar and Bipolar Transurethral Resection of Non-Muscle Invasive Bladder Cancer

“…The authors claimed that B-TURBT seems to represent a promising endoscopic treatment for NMIBC, with good efficacy, reduced morbidity, and fast postoperative recovery compared with M-TURBT. Mashni et al [7] prospectively evaluated pathologic finding and clinical outcomes. This study included 83 patients and there were no significant thermal artifacts in 9 out of 38 (23.7%) and 11 out of 45 (24.4%) monopolar and bipolar specimens respectively.…”