Coagulating intermittent cutting. Improved high-frequency surgery in transurethral prostatectomy.

Area of Science:

• Urology
• Surgical Technology
• Minimally Invasive Surgery

Background:

• Transurethral prostatectomy (TURP) is the standard surgical treatment for symptomatic bladder outlet obstruction.
• While TURP offers excellent long-term results, intraoperative blood loss remains a significant source of morbidity.
• There is a need for techniques that minimize bleeding during TURP.

Purpose of the Study:

• To investigate a novel blood-sparing cutting technology for transurethral prostatectomy (TURP).
• To evaluate the efficacy of 'coagulating intermittent cutting' (CIC cocut BMP) in reducing blood loss during TURP procedures.

Main Methods:

• A standard high-frequency generator was modified with additional electronics to enable 'coagulating intermittent cutting' (CIC cocut BMP).
• The blood-sparing potential of CIC cocut BMP was quantified ex vivo using a blood-perfused porcine kidney model.
• Semi-quantitative assessment of blood loss was performed after multiple cuts through the parenchyma using a standard resectoscope.

Main Results:

• The development of CIC cocut BMP involved iterative improvements, addressing issues like increased operation time and impaired vision from earlier iterations.
• Ex vivo testing demonstrated a significant reduction in observed bleeding with CIC cocut BMP compared to standard methods (p = 0.002).
• The final CIC cocut BMP utilizes constant voltage pulses and controlled pulse intervals for optimized performance.

Conclusions:

• 'Coagulating intermittent cutting' (CIC cocut BMP) represents an improvement over the current gold standard TURP by significantly reducing blood loss.
• The technique is compatible with standard surgical equipment and does not require extensive retraining for surgeons.
• CIC cocut BMP maintains the established surgical principles of TURP, ensuring continuity of care and training.