You will be presented with the full text of a biomedical research paper. Please write an abstract for this paper. Your response should include the abstract and no additional text.

Paper text:
transurethral resection of bladder tumor ( turbt ) is the treatment of choice for non - muscle - invasive urothelial carcinoma .
intraperitoneal perforation is a rare and serious complication of turbt , which can be complicated by increased leakage , systemic absorption of irrigation fluid and by bowel injury .
intraperitoneal bladder perforation , although infrequent , is considered so serious that it requires immediate treatment . traditionally , intraperitoneal perforation has been managed with open surgical repair .
minimal invasive management such as percutaneous peritoneal drainage , or laparoscopic repair of the bladder defect[24 ] have been described ; however , there are no large series or long - term follow - up studies .
laparoscopic bladder repair was safely performed in an old patient as the following case illustrates .
she underwent staging turbt after 4 weeks which again showed t1 high grade urothelial carcinoma .
deep tumor resection was performed using a flat , equatorial loop to resect the posterior wall tangentially . during the resection which took 20 minutes
this was recognized by cystoscopic visualization of the intraperitoneal cavity through a laceration in the middle of the resected area near the dome , while fulgurating the edges at the completion of the procedure .
immediately , exploratory laparoscopy was performed by a colleague from the department of general surgery experienced in laparoscopic techniques showing a 20-mm rupture at the posterior wall of the bladder .
three trocars were used , a 10 mm umbilical trocar and two 5 mm trocars , one in each iliac fossa .
there was no injury to the bowel and the bladder was repaired with two absorbable 2 - 0 vicryl sutures using a one - layer full - thickness suture pattern .
a percutaneous intraperitoneal 12f silicon drain was placed to monitor for possible urine extravasation post operation . for bladder drainage ,
five days after the operation a cystogram revealed no evidence of leak , and the catheter was removed .
intraperitoneal bladder perforation is a rare but serious complication that deserves immediate treatment to prevent complications such as peritonitis , uremia , acidosis , hypervolemia due to irrigant fluid absorption , and tumor cells seeding in the peritoneum .
bladder perforation is more likely to occur in elderly patients who have a thin bladder wall .
the incidence of bladder perforation is difficult to assess because many perforations heal spontaneously and go unnoticed since they do not cause any perioperative and postoperative problems .
therefore , bladder perforations following transurethral surgery may occur much more often than observed or reported in the literature .
balbay et al . carefully evaluated this by performing a cystogram before and after each turbt , and found that 58% of the cases had some extravasation although the surgeon did not believe there was a perforation .
some means to reduce the incidence of bladder perforation are to perform resections in elder patients with special care ( especially for tumors at the dome ) , to avoid overdistension of the bladder , to use the loop in a manner that follows the bladder contour , and to use low power settings on the diathermy unit .
whereas in many patients with small extraperitoneal perforations , free bladder catheter drainage and careful observation is sufficient , such treatment is not enough in patients with significant intraperitoneal perforations . the traditional treatment has been a formal laparotomy with drainage of the intraperitoneal fluid , repair of the perforated area , exclusion of small bowel injury , and placement of intraperitoneal drains . as demonstrated in this case and by others,[24 ]
advantages over open repair are obvious , including less hospitalization and avoidance of the morbidity associated with open surgery . in our opinion , simple bladder drainage might be insufficient , considering that it does not allow any control of the fluid extravasating into the peritoneal cavity during the postoperative period .
continuous or intermittent bladder irrigation can be necessary in these cases to deal with bleeding caused by incomplete tumor resection and insufficient hemostasis . on the other hand , percutaneous placement of a peritoneal drainage tube
might put the patient at risk of bowel perforation or injury to abdominal wall vessels .
moreover , it avoids open surgery and the limits and risks of the standard conservative approaches .
although diagnostic laparoscopy can be performed with either local or regional anesthesia , therapeutic laparoscopic procedures are generally performed using inhalation anesthesia and controlled ventilation .
next , consideration must be given to the special equipment and adequate expertise needed for these procedures .
as demonstrated in this case , the procedure can be performed in cooperation with any surgeon experienced in laparoscopic techniques . according to a consensus statement from 2004 on bladder injuries , ureters or bladder neck
a further major concern of bladder perforation during turbt is the possibility of tumor cell dissemination .
unrecognized bladder cancer seeding after resection may alter the natural course of the disease process .
existing literature supports that bladder perforation during transurethral resection has a slight but possible chance of extravesical recurrence even for a low stage tumor .
noted that of the 11 patients who had bladder perforations during turbt , only 1 had extravesical recurrence .
indicated that open procedures to close the bladder were associated with an increased risk of extravesical recurrence and this negatively impacted patient prognosis .
their statement was based on an extensive review of more than 3,400 patients and 34 instances of bladder perforation .
of course , dissemination alone does not result in metastases , which require target tissue that are receptive and support angiogenesis .
laparoscopic repair should be considered in case of inadvertent intraperitoneal bladder perforation during transurethral surgery .
it can be safely performed and offers an excellent modality for repair of this rare complication even in old patients .
an intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman . 
 the bladder was repaired with a laparoscopic closure and an indwelling urethral catheter . 
 the histopathology revealed t1 high grade urothelial carcinoma . 
 the patient recovered well and was discharged home on postoperative day 7 . 
 this case highlights the successful use of laparoscopy in the treatment of a rare urological complication .