The first resectoscope for transurethral surgery was developed back in 1926. The introduction of such endoscopy allows bladder cancer surgery to be performed via the urethra. However, it is not an easy surgery. Conventionally, the bladder tumour is resected in a piecemeal manner, and the bladder tumour fragments will be flushed out of the bladder. However, there are many floating tumour cells inside the bladder after resection and it is difficult to ensure a 100% clearance of cancer cells upon flushing. Moreover, bladder tumour specimens are fragmented during the surgery, it is almost impossible to assess the resection margins and residual tumour cells at the resection bed may be present. These reasons may account for the recurrence of bladder cancer after surgery.
With the advancement of technology, there are many suggestions as to how we can improve the resection surgery. En bloc resection has been proposed as a new surgical approach in treating bladder cancer. It aims to remove the bladder tumour in one piece, avoiding any fragmentation of the bladder tumour. The bladder tumour specimen remains one whole piece and confirmation of a clear resection margin is possible. Recently, the CUHK Urology team has led an international consensus statement in standardizing the en bloc resection surgery. It serves as the standard of reference for practicing en bloc resection globally.