title: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Urology Service, Department of Surgery, Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY, 10065, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mashni
authors.forename: Guilherme
authors.initials: G
authors.lastname: Godoy
authors.forename: Chadwick
authors.initials: C
authors.lastname: Haarer
authors.forename: Guido
authors.initials: G
authors.lastname: Dalbagni
authors.forename: Victor E
authors.initials: VE
authors.lastname: Reuter
authors.forename: Hikmat
authors.initials: H
authors.lastname: Al-Ahmadie
authors.forename: Hikmat Al
authors.initials: HA
authors.lastname: Ahmadie
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004564:Electrocoagulation; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*