Vasudevan, T (2013) Safety and efficacy of bipolar energy for transurethral resection of bladder tumours. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Bladder cancer is one of the commonest malignancies and worldwide it is the fourth most common malignancy in males and eighth in females. About 70% of patients with Bladder cancer have disease limited to the mucosa or sub-mucosa. This group forms the main bulk of the disease and is termed as non-muscle invasive or superficial bladder cancer. The success of therapy in non–muscleinvasive bladder cancer (NMIBC) relies upon the biologic nature of the tumour and on the treatment chosen. Endoscopic surgery is considered the main treatment of non–muscle invasive tumours (Ta and T1). In 1910, Edwin Beer, changed the paradigm of managing bladder tumours from Open surgery to Endoscopic management. In 1931, the first cutting loop resectoscope was introduced by Stern and McCarthy which gave a boost for transurethral surgeries. Several modifications in technology and technique have evolved, but loop resection remains the gold standard. Endoscopic resection of the growth (TURBT) is the most important and a crucial step in the management of non–muscle-invasive tumours. The objective of TURBT is to (1) Know the histology of the tumour (2) Stage the tumour (3) Grade the tumour and 4) possibly achieve cure. The most common energy source used in TURBT is conventional Monopolar electrosurgery. But Monopolar electrosurgery has its own drawbacks. First, the patient’s body forms a part of the electrical circuit. Second, for irrigation nonconducting solutions like Sterile water, Glycine are used, which increases the incidence of TUR syndrome. Third, the incidence of obturator jerk is more with Monopolar TURBT. So, in order to overcome these drawbacks there has been lots of advances in the surgical technique and technology. One of the improvements in technology is Bipolar energy source, which is well proven for its efficacy and is in common use for TURP. AIM AND OBJECTIVE : The primary aim and objective of the present study is to evaluate the Safety and efficacy of Bipolar energy in resecting bladder tumors and with a secondary objective to study the histological changes (Thermal artefacts) noted in the resected specimens between the Monopolar and Bipolar energy. MATERIALS & METHODS : Institutional Ethics Committee approval was obtained. Informed consent was taken from all patients. All details were recorded as per the Proforma. Patients were randomized into two groups of 50 each to undergo TURBT either Monopolar (Group 1) or Bipolar (Group 2). Patients either underwent Monopolar or Bipolar TURBT in Glycine and Saline respectively. We used the Gyrus ACMI PK system and used PK thin loop for resection. The settings we employed were 160W cutting and 80W coagulation respectively for Bipolar resection. Martin ME MB2 monopolar system was used for Monopolar resection at the setting of 120W cutting and 60W coagulation. The setup of instruments for Monopolar TUR resection is well known. But the setup for Bipolar TUR resection is essentially the same with certain modifications. Inclusion criteria: All patients diagnosed to have Bladder tumour by Ultrasonography, CECT and Cystoscopy. Exclusion criteria: Patients with coagulopathy, Seriously ill patients, Tumours with perivesical extension and metastases, Patients with elevated renal parameters. CONCLUSION : The conclusions that can be drawn from this study are Bipolar resection of Bladder tumours have lower incidence of complications especially bleeding, TUR syndrome, obturator jerks and bladder perforation. The degree of thermal damage is much lesser in histological sections and interpretation of the grade which is one of the most important prognosticators especially in bladder tumours since high grade lesions are proven beyond doubt to progress and reccur. Bipolar TURBT is safe and efficacious in managing bladder tumours.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Safety ; efficacy ; bipolar energy ; transurethral resection ; bladder tumours. |
| Subjects: | MEDICAL > Urology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 10 Aug 2017 02:24 |
| Last Modified: | 10 Aug 2017 06:01 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2551 |
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