Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors – A single-center experience

Maheshwari, Pankaj N; Arora, Amandeep; Sane, Mahesh; Jadhao, Vivek Ganesh

doi:10.4103/iju.iju_348_19

Cited by 12 publications

(16 citation statements)

References 29 publications

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“…14 The choice of irrigation fluid relates to the energy source in use -glycine or mannitol is used in monopolar electrocautery (including monopolar HybridKnife®) [15][16][17][18] and 0.9% NaCl is widely used for bipolar electrocautery [19][20][21] and laser. [22][23][24][25] Distilled water has also been used with laser. 14 Authors describe demarcation of the tumour edge with the energy source in use, generally with a 2-10mm margin of macroscopically normal bladder mucosa; 13-15, 19-21, 25-31 margins of up to 2cm have been described.…”

confidence: 99%

“…15,20,28,32,33 With the use of laser technology, some authors alter the energy settings to provide a coagulation effect for the first line of demarcation, 14,25,34,35 whilst others describe an initial cutting incision. 12,22,23,31,36 The line of demarcation in the bladder mucosa is deepened to the level of detrusor muscle using the energy source of choice, vertically 25 or in a 'fan' shape. 30 The deepening technique may involve, for example, 'flash-firing' short and rapid cutting current of an electrocautery loop, 28 or laser 'cutting' or vapourisation.…”

confidence: 99%

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En bloc transurethral resection of bladder tumors: A review of current techniques

Croghan

Compton

Manecksha

et al. 2021

CUAJ

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Introduction: Growing interest surrounds the concept of en bloc transurethral resection of bladder tumors (ERBT). Theoretical advantages include improved adherence to oncological principles and potential yield of superior pathological specimens. Multiple ERBT methods exist. This review summarizes the current evidence regarding application of differing techniques and technologies to ERBT. Methods: A systematic review of MEDLINE/EMBASE/Scopus databases was performed, using terms “en bloc,” “ERBT,” “bladder,” and “urinary bladder neoplasm.” Template-based data extraction included technique of ERBT, feasibility, tumor size, activation of obturator nerve reflex, operative complications, detrusor muscle sampling rate, and recurrence data. Results: Multiple approaches to ERBT have evolved, using a variety of energy sources. The feasibility of electrocautery, laser, combined waterjet/electrocautery, and polypectomy snare techniques have been confirmed in achieving ERBT. ERBT appears safe, with a low complication rate. The use of laser energy sources reduces the risk of activating the obturator nerve reflex during lateral wall resections. Otherwise, no energy source is unequivocally superior in achieving ERBT. The rate of detrusor muscle sampling is high with use of ERBT and appears superior to that achieved with conventional TURBT (cTURBT) in multiple comparative studies. A limited number of largely non-randomized trials assess bladder tumor recurrence; current evidence suggests this is similar between ERBT and cTURBT groups. Conclusions: En bloc resection of bladder tumors using a variety of technologies is feasible and safe, with a high detrusor muscle sampling rate. Further research is required to determine whether rates of residual disease or recurrence can be reduced with ERBT vs. cTURBT.

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confidence: 99%

En bloc transurethral resection of bladder tumors: A review of current techniques

Croghan

Compton

Manecksha

et al. 2021

CUAJ

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“…Maheshwari et al retrospectively studied 67 patients who underwent holmium laser EBRT for primary NMIBC [11]. The detrusor was present in 85% of the resections.…”

Section: Holmium:yag Lasermentioning

confidence: 99%

En bloc resection for nonmuscle-invasive bladder cancer: selecting a proper laser

Enikeev

Babjuk

Shpikina

et al. 2021

Current Opinion in Urology

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Purpose of reviewTo discuss the most recent surgical lasers that have been made available to us and to evaluate their potential in performing en bloc resection of nonmuscle invasive bladder cancer. Recent findingsLaser en bloc resection of bladder tumors (ERBT) can be performed with a number of laser systems including Ho:YAG, GreenLight, diode, Tm:YAG and thulium fiber lasers (TFL). The data that is currently available suggests that the water-targeting devices (utilizing water as a primary chromophore -Ho:YAG, Tm:YAG, TFL) may have a number of advantages over hemoglobin-targeting systems (potassium titanyl phosphate:YAG, lithium triborate:YAG). One recent addition to the surgical armamentarium Moses effect enhanced Ho:YAG and the TFL (being able to work both in quasi-continuous and SuperPulsed modes) necessitates careful discussion and comparison with the other available devices.

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“…We congratulate the authors[ 1 ] for demonstrating the safety and feasibility of en bloc TURBT with a 100 W holmium laser. We have the following observations:…”

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confidence: 99%

Re: Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en bloc resection of nonmuscle invasive bladder tumors: A single-center experience. Indian J Urol 2020;36:106-11

et al. 2020

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Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors – A single-center experience

Cited by 12 publications

References 29 publications

En bloc transurethral resection of bladder tumors: A review of current techniques

En bloc transurethral resection of bladder tumors: A review of current techniques

En bloc resection for nonmuscle-invasive bladder cancer: selecting a proper laser

Re: Maheshwari PN, Arora AM, Sane MS, Jadhao VG. Safety, feasibility, and quality of holmium laser en bloc resection of nonmuscle invasive bladder tumors: A single-center experience. Indian J Urol 2020;36:106-11

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