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Comparison of various types of lasers and transurethral resection in the treatment of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 2022; 37:95-101. [PMID: 35022872 DOI: 10.1007/s10103-021-03479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
Bladder cancer is one of the most common cancers of the urinary tract. The two available treatments for this malignancy are laser and Transurethral Resection of the Bladder Tumor (TURBT). The aim of this study was to compare the different parameters of these two methods. A systematic search was performed on PubMed, Scopus and Google Scholar between 2000 and 2021. All articles related to non-muscle invasive bladder cancer (NMIBC) were extracted. All analyses were performed using R-studio statistical software version 1.0.136. In total, 11 studies that reported tumor recurrence in two methods were evaluated. A total of 626 and 742 patients were treated with laser and TURBT, respectively. Tumor recurrence, duration of operation, hospitalization and catheterization in laser therapy were significantly lower than TURBT. In addition, the incidence of complications was lower in patients treated with laser. The incidence of obturator nerve reflex, bladder perforation and postoperative bladder irrigation was significantly higher in patients treated with TURBT. Only in relation to postoperative urethral stricture, no significant difference was observed between the two treatment methods. Laser therapy compared to TURBT in patients with NMIBC has fewer complications and faster recovery. Also, the risk of tumor recurrence in laser therapy is less than TURBT.
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Liu Z, Long G, Zhang Y, Sun G, Ouyang W, Wang S, Xu H, Wang Z, Guan W, Yu X, Hu Z, Chen Z, Wang S, Li H. Thulium Laser Resection of Bladder Tumors vs. Conventional Transurethral Resection of Bladder Tumors for Intermediate and High Risk Non-Muscle-Invasive Bladder Cancer Followed by Intravesical BCG Immunotherapy. Front Surg 2021; 8:759487. [PMID: 34820417 PMCID: PMC8606824 DOI: 10.3389/fsurg.2021.759487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 01/04/2023] Open
Abstract
Background: Thulium laser resection of bladder tumors (TmLRBT) is recently considered as a common treatment option for non-muscle-invasive bladder cancers (NMIBC), but whether it is superior to Transurethral resection of bladder tumors (TURBT) are still undetermined. Materials and Methods: We retrospectively screened our institution database to identify patients who were treated by conventional TURBT or TmLRBT for NMIBC and followed by intravesical bacillus Calmette-Guérin (BCG) immunotherapy. The preoperative characteristics, perioperative outcomes, and recurrence-free survival were compared to assess the safety and efficacy of the two procedures. Results: Eventually, 90 patients who underwent TmLRBT (n = 37) or TURBT (n = 53) followed by intravesical BCG immunotherapy were included. Two groups were similar in baseline characteristics except for the smaller tumor size of the TmLRBT group(1.7 cm vs. 2.2 cm; P = 0.036). Obturator nerve reflex occurred in eight patients in the TURBT group and 3 of them suffered from bladder perforation while none happened in the TmLRBT group. The TmLRBT also had a shorter irrigation duration. In the multivariate Cox regression, the TmLRBT was related to less recurrence risk (HR: 0.268; 95% CI, 0.095–0.759; P = 0.013). Conclusion: Our results suggested that TmLRBT is safer than conventional TURBT with fewer perioperative complications, and it offers better cancer control, therefore might be a superior option for NMIBC patients with intermediate and high recurrence risk.
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Affiliation(s)
- Zheng Liu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gongwei Long
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yucong Zhang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Department of Geriatrics, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Sun
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Ouyang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Xu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhihua Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Guan
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Yu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Chen
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Li
- Department of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Institute of Urology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Safety and efficacy of thulium laser resection of bladder tumors versus transurethral resection of bladder tumors: a systematic review and meta-analysis. Lasers Med Sci 2021; 36:1807-1816. [PMID: 33604772 DOI: 10.1007/s10103-021-03272-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
The thulium laser resection of bladder tumor (TmLRBT) is widely used in the treatment of non-muscle-invasive bladder cancer (NMIBC), and we conduct this study to compare the safety and efficacy of TmLRBT with transurethral resection of bladder tumor (TURBT). A comprehensive literature research was conducted using multiple databases, and comparative studies evaluating the safety and efficacy of TmLRBT and TURBT were included. For continuous outcomes, the weighted mean difference (WMD) was used to measure the difference, whereas the risk ratio (RR) with a 95% confidence interval (CI) was calculated for binary variables. Overall, ten studies with 1558 patients enrolled were included in the meta-analysis. The baseline characteristics of two groups were comparable. The operative time (p = 0.24) and catheterization time (p = 0.41) of two groups were similar but the TmLRBT group had a shorter length of hospital stay (p = 0.04). TmLRBT was related to fewer intraoperative complications including obturator nerve reflex (p < 0.001) and bladder perforation (p < 0.001). Although the rate of postoperative irrigation did not significantly differ in our analysis (p = 0.28), the TmLRBT was related to a significantly shorter duration of irrigation (p = 0.004). Besides, the TmLRBT group had a higher rate of identification of detrusor (p = 0.02). However, TmLRBT did not suggest significantly better cancer control than TURBT including the overall recurrence (p = 0.052), 1-year recurrence (p = 0.23), and 2-year recurrence (p = 0.40). Compared with conventional TURBT, the TmLRBT showed superior safety and non-inferior efficacy in cancer control. TmLRBT could also provide high-quality specimens for pathology diagnosis; therefore, it is an as effective option for NMIBC.
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Tao W, Sun C, Yao Q, Fu K, Shan Y, Zhang Y, Xue B, Yang D. The clinical study of en bloc transurethral resection with 980 nm laser for treatment of primary non-muscle invasive bladder cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:563-571. [PMID: 32224536 DOI: 10.3233/xst-190616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To elevate safety and efficacy of en bloc transurethral resection with 980 nm laser as treatment for primary non-muscle-invasive bladder cancer (NMIBC). METHODS Total 84 cases were enrolled in this study. Among them, 36 and 48 cases underwent treatment using the 980 nm laser and the traditional TUR-BT procedure, respectively. The peri-operative characteristics (tumor size, tumor multiplicity, tumor grade, etc.) and intra-operative complications (obturator nerve reflex, bladder perforation, bladder irrigation, etc.) were recorded and compared between the two groups. RESULTS There are no significant difference in baseline characteristics between laser and TUR-Bt treatment groups. Operation time also has no significant difference in two groups. Obturator nerve reflex and bladder perforation were noted in 6 patients and in 3 patients during TUR-Bt group, respectively. No obturator nerve reflex and bladder perforation were observed in the laser group. The patients who need bladder irrigation was lower in laser group than in TUR-Bt group. There were no significant differences in catheterization time and hospitalization time between two groups. No significant difference in the overall recurrence rate were observed among the two groups during the follow-up periods. CONCLUSION En bloc transurethral resection using 980 nm laser is an effective and safe treatment option for non-muscle-invasive bladder cancer. Compared to the traditional TUR-Bt procedure, the procedure using 980 nm laser has fewer perioperative complications and similar oncological results.
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Affiliation(s)
- Wei Tao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chuanyang Sun
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qiu Yao
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Fu
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuxi Shan
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuanyuan Zhang
- Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Boxin Xue
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongrong Yang
- Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou, China
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Tang J, Ye S, Ji X, Li J, Liu F. Comparison of synchronous dual wavelength diode laser versus conventional endo-knives for esophageal endoscopic submucosal dissection: an animal study. Surg Endosc 2018; 32:5037-5043. [PMID: 30116950 DOI: 10.1007/s00464-018-6381-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/10/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) is widely used for en bloc resection in early gastrointestinal cancer. However, it is technically complex with long procedure time and high adverse event rates with using conventional knives. The aim of this animal study was to verify the feasibility of ESD using a novel 980/1470 nm dual diode laser (DDL-ESD) in comparison with conventional knives (C-ESD) in esophagus. METHODS This was an in vivo animal study using eight porcine models. Four were allocated in DDL-ESD group and four were in C-ESD group. Every model underwent two ESDs to remove half circumferential esophageal mucosa. Each model's esophagus was harvested during postmortem at 24 h after ESD. Each specimen underwent gross inspection and histopathological examination was carried out. Procedure time, completeness of en bloc resection, adverse events (bleeding and perforation) and histological injury to muscularis propria were assessed. RESULTS A total of 16 ESD procedures were performed with 100% en bloc resection rate. The procedure speed in DDL-ESD group was significantly faster as compared to C-ESD group (0.27 cm2/min vs. 0.21 cm2/min, p = 0.001). The number of intraoperative bleeding points and the use of haemostatic forceps were significantly lesser in DDL-ESD group (4 ± 2 vs. 8 ± 3, p = 0.016; 1 ± 1 vs. 3 ± 2, p = 0.029). Histological assessment showed that injury to muscularis propria in DDL-ESD was milder than C-ESD. There was no perforation observed in both groups. CONCLUSIONS DDL-ESD technique appears to be safer and faster than C-ESD with less bleeding and injury to deep tissues.
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Affiliation(s)
- Jian Tang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shufang Ye
- Department of Gastroenterology, Lishui people's Hospital, Lishui, Zhejiang, China
| | - Xueliang Ji
- Department of Gastroenterology, Lishui people's Hospital, Lishui, Zhejiang, China
| | - Jun Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Feng Liu
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Mid Yanchang Road, Shanghai, 200072, China.
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Xu H, Ma J, Chen Z, Yang J, Yuan H, Wang T, Liu J, Yang W, Ye Z. Safety and Efficacy of En Bloc Transurethral Resection With 1.9 µm Vela Laser for Treatment of Non-Muscle-invasive Bladder Cancer. Urology 2017; 113:246-250. [PMID: 29198850 DOI: 10.1016/j.urology.2017.11.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/07/2017] [Accepted: 11/18/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of 1.9 µm Vela laser in treatment of primary non-muscle-invasive bladder cancer. METHODS The data of the patients with non-muscle-invasive bladder cancer treated by either en bloc transurethral resection with 1.9 µm Vela laser (n = 26) or conventional transurethral resection of bladder tumor (n = 44) were analyzed retrospectively. The preoperative characteristics and intraoperative complications were compared in the 2 groups. RESULTS Patients who were treated by 1.9 µm Vela laser obtained a higher rate of specimens meeting the requirements of pathologic assessment for tumor staging compared with the patients treated by conventional transurethral resection of bladder tumor. No obturator nerve reflex and bladder perforation occurred during surgery in the 1.9 µm Vela laser group. However, 7 patients in the conventional transurethral resection of bladder tumor group encountered obturator nerve reflex, and 3 of them encountered bladder perforation (P <.05). There were no significant differences between the 2 groups in operative duration and transfusion rate. Patients in the 1.9 µm Vela laser group had shorter postoperative continuous bladder irrigation time than that in the conventional transurethral resection of bladder tumor group. There was no significant difference in the overall recurrence rate between the 2 groups during the follow-up periods. CONCLUSION En bloc transurethral resection with 1.9 µm Vela laser in the treatment of non-muscle-invasive bladder cancer demonstrates an advantage over conventional transurethral resection of bladder tumor in reducing intraoperative complications, improving the quality of the specimens admitted for pathologic assessment, and shortening the duration of postoperative continuous bladder irrigation.
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Affiliation(s)
- Hao Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jun Ma
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhong Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Jun Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Huixin Yuan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Tao Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Jihong Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Weimin Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China; Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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Knezevic N, Kulis T, Maric M, Grkovic MT, Krhen I, Kastelan Z. Laparoscopic partial nephrectomy with diode laser: a promising technique. Photomed Laser Surg 2014; 32:101-5. [PMID: 24460067 PMCID: PMC3926155 DOI: 10.1089/pho.2013.3646] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). BACKGROUND DATA LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. PATIENTS AND METHODS We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤ 4 cm, predominant exophytic growth and intraparenchymal depth ≤ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. RESULTS We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. CONCLUSIONS Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.
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Affiliation(s)
- Nikola Knezevic
- Department of Urology, University Hospital Center Zagreb, University of Zagreb School of Medicine , Zagreb, Croatia
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