Presented by: T. Max Shelton MD
Indiana University School of Medicine

Introduction

Tissue morcellation has become increasingly efficient, yet remains a rate limiting step in holmium enucleation of the prostate (HoLEP). Limited data exists on how the rate of oscillation by the morcellator blades affects morcellation efficiency (ME).

Materials

A retrospective review was performed of our HoLEP procedures performed by two surgeons from 7/1/2019 to 8/25/2022. All morcellation was performed with the Wolf Piranha device and enucleation was performed with Moses 2.0 technology. Surgeon 1 routinely uses 1500 oscillations/min (low rate) and Surgeon 2 uses a rate of 6000 oscillations/min (high rate). The primary endpoint was morcellation efficiency (grams/minute). Secondary endpoints include enucleation efficiency, mean tissue specimen weight, and preoperative prostate volume. The data was also subgrouped into small and large specimen weights (<150 gms and >150 gms) to delineate any differences based on amount of tissue.

Results

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94 HoLEPs were analyzed, 302 by Surgeon 1 and 592 by Surgeon 2. Surgeon 2 had larger preoperative prostate volumes (126 vs 101; p<0.001) and specimen tissue weights (86.0 vs 61.1; p<0.001). Morcellation time was longer in the low rate group (11.3 vs 6.1 min, p<0.001) and ME was lower in the low rate group (9.3 vs 12.1 g/min, p<0.001). The difference in ME was inversely proportional to specimen weight. When the data was subgrouped by specimen weight (<150 gms and >150 gms), there was a significant difference below 150 gms (9.3 vs 12.3; p<0.001) in ME, yet no significant difference in the large tissue group (8.8 vs 9.4; p=0.42).

Conclusion

Increased oscillation rate during morcellation leads to a decrease in morcellation time and increased morcellation efficiency during prostate enucleation. Future prospective studies will serve to evaluate this finding across a larger numbers of institutions, and evaluate ways to increase ME in large prostate cohorts (i.e. >150 gms).     

Funding

None

Co-Authors

Cameron McClaine,
Indiana University School of Medicine

Andrew Adeola,
Indiana University School of Medicine

RJ Caras, DO
Indiana University School of Medicine

Austen Slade, MD
Indiana University School of Medicine

Deepak Agarwal, MD
University of Minnesota School of Medicine

Tim Large, MD
Indiana University School of Medicine

Marcelino Rivera, MD
Indiana University School of Medicine