Editing Transurethral Resection of Bladder Tumour (section)

== Resection ==

* '''See [https://pubmed.ncbi.nlm.nih.gov/21156035/ BJUI Surgical Atlas] for details and figures'''
*See [https://www.youtube.com/watch?v=FixJhTX3Fy0 Video] (Dr. Divakar Dalela)
*See [https://www.youtube.com/watch?v=Vl4Ojb_2dVk Video] (Dr. Brojen Barman)
*'''2016 AUA NMIBC Guidelines: During resection, tumors of significant size should be resected and labeled'''
*'''2015 CUA NMIBC Guidelines: Complete resection of all visible tumours with adequate depth to include muscularis propria should be performed, when feasible'''
** Campbell’s: The necessity of obtaining detrusor muscle in the surgical specimen is widely taught but not established in benefit. For example, the potential for muscle invasion for low-grade disease is essentially nonexistent, so a transmural biopsy offers little potential benefit compared with the risk of bladder perforation incurred
*'''Resection is performed piecemeal, delaying transection of any stalk until most tumor has been resected''', to maintain countertraction. 
**Friable, low-grade tumors can often be removed without the use of electrical energy because the nonpowered cutting loop will break off many low-grade tumors. This minimizes the chance of bladder perforation and unnecessary cautery damage or loss of specimens.
**Higher-grade, more solid tumors and the base of all tumors require the use of cutting current; cautery yields hemostasis once the entire tumor has been resected. 
***'''Lifting the tumor edge away from detrusor lessens the chance of perforation'''
*'''Resection should include an approximate 2-cm margin of normal-appearing tissue'''
**Histologically, bladder tumors frequently exhibit growth beyond the visible edge
* '''If tumour overlying ureteral orifice, only use cutting current and resection strokes should be as quick as possible to minimize the possibility of cauterizing the ureteral orifice closed.''' 
**Data suggest routine stenting is not necessary following ureteral orifice resection.