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TURBT – Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT) in Cambodia

TURBT - Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT) in Cambodia
FB Dr Soarawee
Soarawee Weerasopone, MD

Minimally Invasive Uro-Oncologist
Royal Phnom Penh hospital, Kingdom of Cambodia

Since Royal Phnom Penh hospital is the first ever hospital in Cambodia which succeed preforming in Ho-ERBT operation, so this topic, I’m going to mention and classify over the Pros and the Cons of the Ho-ERBT. First, let’s start with endoscopic TUR-BT, which is the conventional operation in endoscopic bladder tumor removal. TURBT is abbreviation from “Transurethral resection of the bladder tumor” 

TURBT - Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT) in Cambodia
Royal Phnom Penh hospital is the first ever hospital in Cambodia which succeed preforming in Ho-ERBT operation.

The methodology of the conventional TURBT is passing the scope via urethra and then use a small electrical surgical knife for scooping bladder mass. Imagine you’re now scooping an ice cream, there could be a hundred scoops in a single TURBT operation which is any scoop possibly makes the surgical field bleeding, another con is a risk of bladder perforation, due to TURBT procedure needs electrical power to do cutting method and this electrical activity can naturally induce to a reflex named “Obturator reflex” which is making subconscious lower part of body contraction during the cutting moment. You cannot imagine how terrified it is if this event happening, yes, perforated bladder can be occurred and possible leading to emergency open surgery operation. But we don’t have to worry about this Ho-ERBT, because the laser beam will not introduce to an obturator reflex.

TURBT - Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT) in Cambodia
Endoscopic view of Bladder tumor

Ho-ERBT is an Endoscopic laser prostate operation which is using Holmium YAG laser technology. This surgical technique is also very interesting. By just not a small scooping one by one like conventional TUR-BT. Ho-ERBT can excise bladder tumor in just one specimen. Sound a lot better from conventional TUR-BT and seeming like no cons at all, right? But let me show you the Pros and the Cons on this. 

TURBT Ho-ERBT’s Pros

  1. Less bleeding when compared with conventional TURBT
    • Due to the Holmium laser can resect and secure the bleeding at the same time.
  2. Less hospitalization periods compared with conventional TURBT
    • There were confirmed reports show that Ho-ERBT patient can be discharged significantly faster than TUR-BT
    • 2 days VS 4 days
  3. Less risk of bladder perforation
    • Like I have mentioned previously, we don’t have to be cautious with unexpected obturator reflex.
  4. Less postoperative irritation symptom

TURBT Ho-ERBT’s Cons

  1. Steep learning curve for surgeons 
    • At least 25 cases of learning curve are required for an adequate Ho-ERBT operation. 
  2. Special equipment in a well-equipped center 
    • These bring out more medical expense on Ho-ERBT comparing to the conventional TUR-BT. 
TURBT - Holmium laser en-bloc resection of the Bladder tumor (Ho-ERBT) in Cambodia
At least 25 cases of learning curve are required for an adequate Ho-ERBT operation.

In conclusion, Ho-ERBT is considered as one of the best endoscopic bladder tumor removal operation which is required a well-trained urologist. Any questions, you should’ve discussed with your trusted urologist, or you can text me anytime. See you in next article! 

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