Bladder cancer is the most common malignancy of the urinary system in China, and in about 3/4 of these cases, the tumor is still found in a superficial – non-muscle infiltrative stage, meaning that the muscular layer of the bladder wall has not yet been involved, and can usually be removed by transurethral resection of bladder tumors (TURBt), followed by bladder irrigation therapy. TURBt involves removing the tumor and the underlying tissue layer by layer by means of a metal electrodesiccation ring with an electric current flowing through it, so that it must be removed one piece at a time and then the tissue fragments are removed by flushing. During this process, the shredded tumor tissue releases a large number of tumor cells that can enter the surrounding tissue during removal and begin to grow again there, causing recurrence of bladder cancer. The removed tumor tissue fragments can only be barely evaluated in postoperative pathological examination, and it is impossible to determine whether all tumor cells have been removed and eliminated, and it is not possible to accurately perform clinical staging of bladder tumors, which creates a big obstacle for postoperative patients’ subsequent treatment, follow-up plan selection, and prognosis judgment. For high-risk tumors, a second surgery is required. TURBt surgery for tumors in the lateral bladder wall may also cause closed nerve reflexes, leading to bladder perforation and causing dissemination of tumor cells. In recent years, transurethral resection of whole bladder tumors has started to become a new trend in early bladder tumor surgery. In this surgical approach, the bladder tumor, tumor base and part of the forced urinary muscle tissue are removed as a whole and taken out of the body through a specially designed specimen bag. This surgical approach effectively reduces intraoperative tumor dissemination and reduces the possibility of postoperative recurrence; avoids secondary surgery; and obtains complete pathological specimens, which provides the most reliable basis for postoperative patient follow-up treatment, selection of follow-up protocols, and prognostic judgment. Transurethral resection of whole bladder tumor early on mostly used the method of rod electrode, which is slow and also has the risk of closed nerve reflex. At present, we are the first in China to perform BT-ESD, using a hybrid hydroelectric cutting system (Haber knife) from ERBE (Germany). This high-tech device achieves two functions: it can lift the tumor by high-pressure waterjet and then separate it from healthy tissue intact by high-frequency electric knife. We apply a hair-thin waterjet to the bladder mucosa at a pressure of about 25 bar, lifting the mucosa along with the tumor. The tumor now sits in an elevated position above the water pad. This facilitates complete debridement of the tumor with the HF electric knife. At the same time, the water pad prevents damage to the bladder wall. Advantages of BT-ESD: precise and complete removal of the bladder tumor, even larger tumors can be clearly removed as a whole, minimal dissemination of tumor cells, preservation of tissue, reliable operation, high diagnostic certainty thanks to better evaluation material, and potentially less follow-up surgery. Transurethral resection of the entire bladder tumor can also be performed by laser, a technical tool that allows complete avoidance of the closed nerve reflex and better hemostasis.