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Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens? An in
Yi Cai1, Avrum Jacobson, Robert Marcovich
1Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Objectives:
To compare the safety and efficacy of morcellation with the electrical prostate morcellator (EPM) or manual morcellation of the kidney, using an internal view within the morcellation sac.
Methods:
Thirty porcine kidneys, mean renal mass 174.5 g, were divided into three groups of 10. All morcellations were performed inside the LapSac. Groups 1 and 2 underwent morcellation using the EPM, monitored inside the LapSac using the nephroscope and outside the LapSac with the laparoscope, respectively. Group 3 underwent manual morcellation with ring forceps. The groups were assessed for morcellation time, fragment size, and LapSac integrity.
Results:
In group 1, one pinhole perforation occurred; in group 2, nine perforations occurred (five large and four pinhole). No perforations occurred (P <0.001) in group 3 (manual morcellation). The mean morcellation time for groups 1 through 3 was, respectively, 86.9, 47.1, and 15.1 minutes (P <0.0001). The corresponding mean fragment size was 0.011, 0.015, and 1.36 g. The difference in mean fragment size was significantly different between the manual morcellation group and the EPM groups (P <0.001), but not between the two EPM groups (P = 0.12).
Conclusions:
Manual morcellation was safe, fast, and superior to morcellation with the EPM monitored either inside or outside the LapSac. The high rate of LapSac perforation precludes the use of EPM after laparoscopic radical nephrectomy in the clinical forum.
Insights
Manual morcellation of kidneys proved safer and faster than using the electrical prostate morcellator (EPM). The EPM showed a high rate of LapSac perforation, limiting its clinical use.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Technology
Background:
- Kidney morcellation is a key step in laparoscopic radical nephrectomy.
- Ensuring safety and efficiency during morcellation is crucial for patient outcomes.
- The electrical prostate morcellator (EPM) is a newer technology for tissue morcellation.
Purpose of the Study:
- To compare the safety and efficacy of manual kidney morcellation versus morcellation using the electrical prostate morcellator (EPM).
- To evaluate LapSac integrity and morcellation characteristics during these procedures.
Main Methods:
- Thirty porcine kidneys were divided into three groups (n=10 each).
- Groups 1 and 2 underwent EPM morcellation (monitored internally and externally, respectively).
- Group 3 underwent manual morcellation with ring forceps, all within a LapSac.
Main Results:
- Manual morcellation resulted in zero LapSac perforations, compared to significant perforations with EPM (P <0.001).
- Mean morcellation time was significantly shorter for manual morcellation (15.1 min) versus EPM (86.9 min and 47.1 min) (P <0.0001).
- Manual morcellation produced larger fragments (1.36 g) compared to EPM (0.011-0.015 g) (P <0.001).
Conclusions:
- Manual morcellation is a safe, rapid, and effective technique for kidney morcellation.
- The high rate of LapSac perforation with EPM restricts its current clinical application.
- Further research may be needed to improve EPM safety for kidney procedures.
