Surgical technique
Portable setup
After the experience of the application of portable wireless cameras during laparoscopic surgery, our team developed a new cystoscopic setup. (6, 7) The new setup was created by coupling a rigid 30°, 4-mm cystoscope with a GoPro HERO5 camera (wireless camera) using a Back-Bone Ribcage H5PRO adaptor (special adaptor). The light source used was a portable and rechargeable LED cold light source (Figure 1). A modified plastic bag was used to ensure sterile conditions, with the camera contained inside.
The specific camera we used has the ability to transmit the signal wirelessly to a tablet computer, mirroring this way, the camera image to a secondary monitor (tablet computer). This is very important for the surgeon as the large tablet screen may project in detail the anatomical structures. This way, it is easier to conclude a correct diagnosis, and performed cystoscopy is more convenient.
Cystoscopy technique
Initially, the patient is in the dorsal lithotomy position, and the vaginal introitus is prepared with normal saline. Lidocaine hydrochloride 1% gel can be used as a local anesthetic and lubricant. A rigid, 30° narrow caliber cystoscope is introduced into the urethra. We infuse normal saline at a 150 mmHg pressure and visualize the urethral wall and direct the cystoscope into the bladder. On entering the urinary bladder, the cystoscope should be tilted downwards to enable the operator to initially visualize the neck and then the urinary bladder’s trigone. In case of intraoperative performance, the patient is already under general or epidural anesthesia. In the case of diagnostic cystoscopy, there is no need for anesthesia, except that a pigtail catheter must be introduced or replaced that the patient must be anesthetized.
Our Department performs diagnostic cystoscopy in selected vaginal and abdominal operations, mostly TVT vaginal tapes for urine incontinence, vaginal hysterectomies, and cancer staging (cervical). We applied the new setup in more than 50 diagnostic cystoscopies and pigtail catheter replacement so far effectively and without complications. As demonstrated in video 1, image quality is excellent for the surgeon to complete the cystoscopy without any problems.