Introduction

Transurethral en bloc resection of bladder tumor with a dual channelized flexible cystoscope using an Impact Shooter in human cadavers embalmed by Thiel&[prime]s model.

Methods

This study was approved by the institutional review board of Sapporo Medical University. Four human male cadavers (73 to 86 years old) embalmed by Thiel&[prime]s method were used as a model for performing ESD. A flexible cystoscope (CYF-200; OLYMPUS) was used to perform ESD (Fig. 1a). We used a transparent attachment with a tube of diameter 2.8-mm (Impact Shooter N type 6.0-mm diameter; Top Co.). It is designed for devices such as ESD knives and enables the endoscope to work like a dual channel scope (Fig. 1b). We used an electrosurgical knife (Dual Knife, 2.7-mm diameter; OLYMPUS), commonly used for gastrointestinal tract&[prime]s ESD (Fig. 1c). A circular area of 1.0-2.0-cm diameter was defined in the bladder and identified as the target area for resection (Fig.2a-c).

Results

The ESD technique was applied into 5 places of bladder per cadaver. Although the target areas were successfully resected from the four cadavers (Fig.2d), one small bladder perforation occurred. In total 20 procedures, the median size of the resected pieces ex vivo was 1.4 cm (range 0.8-2.0 cm), and the median time taken to resect each target piece was 9.0 min (range 4.0–17.0 min). Endoscopic procedures of bladder using a flexible cystoscope with an Impact shooter was technically feasible in the human male cadavers. However, the handling of the tool was slightly difficult because of the poor flexibility of the additional attachment and the influence of the relative hardness of the urethra of cadavers as compared to healthy persons.

Conclusions

Transurethral ESD technique using a flexible cystoscope was considered technically feasible for the small bladder tumors. We hope that in the near future a new flexible cystoscope with dual and large caliber channels will be developed in order to facilitate ESD technique.

Funding

none