Standardized comparison of prostate morcellators using a new ex-vivo model

Transurethral laser enucleation of the prostate is a common therapeutic option for the treatment of benign prostate enlargement. Evacuation of the enucleated tissue from the bladder is usually performed by electric morcellators. Until now, a standardized evaluation of the different morcellator settings does not exist. Therefore, we developed an ex-vivo model to find the best settings for four different morcellators.

We morcellated pieces of a prostate adenoma after an open adenomectomy. The same speed settings were used to morcellate commercially available minced meat, fine pork sausage meat, and bovine heart, all of which had been cooked for 10 minutes using a Piranha Morcellator. We also morcellated raw pig perirenal fat tissue, raw pig liver, and raw bovine heart. The pieces were morcellated at different speed settings in an open water tank filled with saline. Because raw bovine heart showed to be the most equivalent tissue, we morcellated five pieces with four different settings of four different morcellators: The Piranha, the VersaCut, and two morcellator prototypes.

The median retrieval rate for the prostate adenoma was 14.02 (3.7-19.8) g/min. The retrieval rate for raw bovine heart was 13.75 (5.66-20) g/min. The maximum morcellation rates of the morcellators were: Piranha 20 (19.3-21.4) g/min, VersaCut 10.8 (8.2-13.1) g/min, Karl Storz prototype 9.8 (7.9-10.76) g/min, and Richard Wolf prototype 38.6 (35.3-42.9) g/min.

Raw bovine heart tissue is suitable for ex-vivo testing of prostate morcellators and can replace human prostate tissue in this standardized setting. In our ex-vivo study, the morcellation rates of the different morcellators increased with optimized oscillation speed and suction power settings. This needs to be confirmed in clinical studies.