(A) An intraoperative view. A midline lapartomy was performed and the bladder isolated. The lights in the operating room were turned off. The surgeon pointed the cystoscope toward one of the poles of the planned ellipse around the tumor. The assistant marks this point with a cautery. (B) The marked incision was deepened, the bladder edge lifted with Allis clamps, and the tumor identified. (C) A removed specimen showing only a crater. (D) A removed specimen showing a bulky (pT3) tumor. This patient was operated on at the age of 54 years and is disease-free 85 months after surgery.