4. Evacuation of the Tumor

Description

• < 2 cm specimens can easily be grasped between the loop and the extremity of the inner sheath, which is then disconnected to allow the safe extraction of the specimen within the outer sheath.
• Large specimens are sometimes amenable to the same manner of extraction. Alternatively, the specimen can be fragmented either by standard resection of the exophytic bulk of the tumor before completing the en bloc dissection of the tumor insertion onto the bladder wall or by fragmenting the en bloc specimen at the end of the dissection.

Key Insights

• At the end of the procedure, it is helpful to leave a few strands of fiber between the tumor and the site of resection in order to avoid the floating of the specimen and facilitate its retrieval.
• While it is a rare location for primary tumors, many recurrences are observed at the anterior part of the bladder. Floating tumor cells have been implicated in early recurrences. Debris and microbubbles are often observed at the dome at the end of the procedure; they can be easily removed by suction by overinflating the bladder, inserting the tip of the resectoscope close to the debris, and disconnecting the inner sheath.