经尿道单孔腔镜膀胱肿瘤整块切除术的离体动物模型实验研究

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Experimental study of en-bloc resection of bladder tumors by transurethral single-port laparoscopy in vivo animal models

WANG Weifeng ZHANG Jun WAN Jiansheng LIU Siming ZOU Yuan ZHENG Shaoqiu HAO Jidong LIAO Guoqiang GONG Hua OUYANG Lei1

ABSTRACT：Objective To explore the feasibility of en-bloc resection of bladder tumors by flexible cystoscope combined with laparoscopic instruments through urethra and to provide reference for the clinical application of this technique.Methods Self-designed and processed transurethral single-hole PORT and Olympus electronic cystoscope were used as observation mirror；Φ1.8 mm soft grasper，tissue scissors，electric hook，and ultrasonic scalpel were used as instruments；the porcine bladder was used as a model.The PORT was placed through the urethra，and the cystoscope was inserted to observe the inner wall of the bladder and the condition of the mucosa.After the lesion site was identified in the bladder cavity，the soft grasper was inserted to pull the mucosa to be removed，which was then fixed with tension at the target position to maintain a satisfactory feild of view.The surgeon held the cystoscope in the left hand，and operated the laparoscopic instruments into the bladder cavity through the PORT with the right hand.Observing with the cystoscope and lifting and pulling the mucosa with the grasper，the surgeon simulated the cutting and pushing actions to realize the en-bloc resection of the lesioned mucosa.Results The mucosa at 4 different locations were successfully resected on 2 in vitro porcine bladder models.Conclusion The in vitro experiments show that the combination of flexible electronic cystoscope and laparoscopic instruments achieves synergistic effects in en-bloc resection of bladder tumor by transurethral single-hole laparoscope without additional iatrogenic bladder injury caused by percutaneous bladder incision.This method is feasible in the treatment of bladder tumors，and has the potential of clinical application after further optimization.

KEY WORDS：transurethral；flexible cystoscope；soft grasper；laparoscopic instruments；bladder tumor;en-bloc resection；animal model；in vitro；porcine bladder

摘要：目的 探讨电子膀胱软镜联合腹腔镜器械经尿道协同操作实施膀胱肿瘤整块切除的可行性，为该技术的临床应用提供参考。（剩余6257字）