Ex vivo comparison of available morcellation devices during holmium laser enucleation of the prostate through...

BACKGROUND and Purpose: Holmium laser enucleation of the prostate (HoLEP) is a recognized option for surgical management of benign prostatic hyperplasia (BPH). While laser parameters and enucleation techniques have been widely investigated, morcellation techniques remain poorly evaluated in the literature. Our goal was to objectively evaluate the available devices used for morcellation during HoLEP.

An in vitro evaluation of two morcellators (Lumenis and Wolf) and two nephroscopes (Wolf and Storz) was conducted. For morcellators, the following parameters were assessed: Aspiration power (time to aspirate 1 L of water), morcellation power (g of baked chicken meat morcellated in 2 minutes), and visual control of the cutting part of the device (visible or not visible). For nephroscopes, data collected were: Field of vision (measured on a 4 cm distant sight) and irrigation flow (time needed to drain a 3-liter bag of water suspended at 1 m of height).

For the Wolf and Lumenis morcellators, aspiration power parameters were 20.4 mL/s and 22.2 mL/s, and morcellating power parameters were 2.5 g and 6 g of tissue per minute, respectively. The cutting part of the Wolf morcellator was permanently under control during the procedure, whereas the distal part of the cutting device was out of vision control with the Lumenis. Evaluation of Storz and Wolf nephroscopes showed that field of vision was larger with the Storz, and irrigation flow was 0.35 and 0.52 L/min, respectively.

The Storz nephroscope has a greater field of vision but less important blood flows. The Lumenis morcellator is faster than the Wolf morcellator. These objective data could set up the basis for a prospective trial comparing the two devices.