A novel resectoscope for transurethral resection of bladder tumors and the prostate.
OBJECTIVE
Transurethral bladder tumor resection is associated with imperfect clinical staging and incomplete tumor removal. Transurethral prostate resection may be complicated by inadvertent damage to the urinary sphincter, bladder neck and trigone. We performed a multicenter pilot and feasibility study of a novel working element for resectoscopes designed to improve the efficacy and safety of transurethral endoscopic surgery.


METHODS
An innovative working element for resectoscopes was developed to convert the standard in/out linear/axial movement at the handgrip into a side-to-side, bidirectional, lateral rotating motion. The device is compatible with current optical technology and conventional electrocautery generators, and it has been granted marketing approval. It consists of variably sized cutting loops designed for transurethral resection of bladder tumors and the prostate. To date 80 patients with bladder cancer (38) or benign prostatic hyperplasia (42) have undergone surgery with this instrument at our 3 clinical sites.


RESULTS
No safety concerns were evident. When used during transurethral bladder tumor resection, lateral resection at the base of the tumor enabled accurate depth of penetration into the bladder wall, which may decrease the risk of bladder perforation and improve pathological assessment of tumor invasion. During transurethral prostate resection this novel tool facilitated dissection of adenoma adjacent to the verumontanum and prostatovesical junction, which may decrease the risk of sphincteric damage and bladder neck injury.


CONCLUSIONS
A novel resectoscope is currently under prospective clinical investigation to establish its surgical and pathological efficacy, ease of use and side effect profile. Current data suggest that the learning curve is mild, its use is safe and it provides distinct advantages when used for transurethral resection of bladder tumors and the prostate.
Pantuck
Allan J
AJ
Department of Urology, David Geffen School of Medicine at University of California-Los Angeles, 10833 Le Conte Ave., Room B7-298A CHS, Los Angeles, California 90025-1738, USA. apantuck@mednet.ucla.edu
Baniel
Jack
J
Kirkali
Ziya
Z
Klatte
Tobias
T
Zomorodian
Nazy
N
Yossepowitch
Ofer
O
Belldegrun
Arie S
AS
D000328:Adult; D000368:Aged; D019723:Endoscopes; D004867:Equipment Design; D004869:Equipment Safety; D005069:Evaluation Studies as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D010865:Pilot Projects; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D020728:Transurethral Resection of Prostate / Q000295:instrumentation*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*