title: Bipolar energy for transurethral resection of bladder tumours at low-power settings: initial experience.
abstract: Study Type - Therapy (case series).
  
  
  METHODS
  4.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of using bipolar energy at low-power setting for transurethral resection (TUR) of bladder tumours.
  
  
  METHODS
  In total, 108 patients (100 males and eight females) with superficial bladder carcinoma undergoing bipolar TUR of bladder tumours (B-TURBT) with the Gyrus(TM) Plasma kinetic Tissue Management System (Gyrus Medical Ltd, Cardiff, UK) were studied. The initial ten patients were operated at a default setting of 160 W cutting and 80 W coagulation. Subsequently, the current settings were modified to 50 W cutting and 40 W coagulation. The present study reports on the 98 patients who underwent TURBT with low-power settings. Tumour number, size, shape, location, operating time, hospital stay, blood loss, as well as intraoperative and postoperative complications, were all recorded .The resected tissues were examined by a pathologist who recorded grade, invasion of the muscularis propria and the presence of muscular invasion.
  
  
  RESULTS
  Out of the ten patients who were operated at the recommended default settings of 160 W cutting and 80 W coagulation, three patients had obturator jerks leading to two-bladder perforation. The results of 98 patients operated on at the low-power settings of 50 W cutting and 40 W coagulation are reported. Mean ± SD age was 56.34 ± 13.51 years. Tumours were multiple in 62 (63%) patients and single in 36 (37%) patients, with 68 (69%) in the lateral wall and six (6%) involving the ureteric orifice. Mean ± SD tumour size was 2.5 ± 0.81 cm with a mean ± SD resection time of 36.64 ± 16.5 min. The mean drop in haemoglobin was 0.94 ± 0.71 (0.20-4.0), with a mean ± SD (range) drop in haematocrit of 1.33 ± 1.29 (1-7). Five (5%) patients required blood transfusion as a result of preoperative low haemoglobin. Mean ± SD drop in sodium was 2.06 ± 0.66 mEq/L, with no patient developing TUR syndrome. None of the 98 patients developed obturator jerks and perforation at low-power settings. Complete resection was achieved in 94 (96%) patients. Mean postoperative hospital stay was 3 days.
  
  
  CONCLUSIONS
  TURBT using bipolar energy is safe and effective in the treatment of bladder tumours at power settings lower than the conventionally recommended settings. Lower power settings reduce the number of obturator jerks and perforations.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@gmail.com
authors.forename: Narmada P
authors.initials: NP
authors.lastname: Gupta
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Saini
authors.forename: Prem N
authors.initials: PN
authors.lastname: Dogra
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*