Tips and Tricks for Safe Morcellation with the Lumenis VERSACUT

Abstract

Introduction:

Holmium laser enucleation of the prostate (HoLEP) is an effective treatment option for bladder outflow obstruction secondary to prostatic enlargement. However, concerns about bladder mucosal injuries secondary to morcellation of the prostatic adenoma after enucleation slow the learning curve and prevent some urologists from learning the procedure. We reviewed 13 years of experience in a single center and suggest some tips and tricks to perform a safe and quick morcellation.

Materials and Methods:

A retrospective review of a prospective database of all HoLEP procedures performed by or under supervision of a single consultant urological surgeon was undertaken. Laser enucleation was performed using the Lumenis Pulse™ 120 Holmium laser and morcellation with the Lumenis VERSACUT™ tissue morcellator system. Data were recorded for morcellation time, retrieval time, and specimen weight and all case notes were reviewed for morcellation injury.

Results:

Between December 2003 and March 2017, 1016 cases of HoLEP were performed at our center. Median patient age was 72 years (range 41–95). Median time required for morcellation was 10 minutes (range 1–120) (n = 525). The median specimen weight in these patients was 30 g (range 0.7–256) (n = 502). Retrieval of the remaining prostatic adenoma using a cold curette was necessary in 36 (6.9%) cases; median time for retrieval was 5 minutes (range 1–65). Of the 1016 cases performed, there was no incidence of bladder mucosal injury.

Conclusions:

Our case series using the Lumenis Versacut™ tissue morcellator demonstrates that morcellation can be performed quickly and safely. These are some of the tips and tricks that are used at our center. (1) Make a smooth transition to morcellation without emptying the bladder to prevent bleeding that could interfere with vision during morcellation. (2) Use two ports of irrigation to keep the bladder full and, therefore, away from the morcellator. (3) Ensure the irrigation fluid does not run out to also keep the bladder full. (4) If the adenoma stops “dancing,” drop it and re-engage to prevent it from becoming polished and difficult to remove. (5) Flush the inner blade should the suction stop working. (6) Slow down morcellation when pieces become small to prevent them falling off the morcellator. (7) Use a cold curette to remove any small polished “beachballs.” (8) Always check the prostatic fossa for any hiding pieces of prostatic adenoma. By following these tips and tricks, morcellation after prostate enucleation can be performed quickly and safely.

Patient Consent Statement:

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

Mark Cynk is a training course organizer and meeting participant for Lumenis, Inc. Danielle Whiting has no competing financial interests.

Runtime of video: 5 mins 6 secs

Abstract Presentation: Whiting D, Cynk M. Tips and Tricks for Safe Morcellation After Prostate Enucleation. Video presented at World Congress of Endourology; 2017 September 12–16; Vancouver, Canada.