Prostatic Adenoma Suprapubic Morcellation with Arthroscope Shaver System: An Inexpensive and Safe Opition

Abstract

Introduction and Objectives:

The removal of the enucleated adenoma after prostatic endoscopic enucleation has been a constant challenge to overcome, especially in low-income countries. ^{1 –6}

The development of endoscopic morcellators has brought about significant advancements, with a notable decrease in surgical time. ⁷ When morcellators are not available or the equipment is broken, the “mushroom technique” or even a cystotomy through a suprapubic incision may be used. ⁸

This video presents a suprapubic morcellation with an orthopedic shaver and a suprapubic disposable morcellation blade, a new minimally invasive alternative for scenarios when the endoscopic morcellator is not available.

Materials and Methods:

After the enucleation was completed with rigorous hemostasis of the prostatic cavity, suprapubic access to the bladder was achieved through a puncture with a disposable 5 mm laparoscopy trocar under direct endoscopic view, close to the bladder neck, which allows greater visual control for morcellation.

Next, the blade was introduced and connected to the assembly handpiece and the suction rubber. The rotation was set to 3000 rpm in oscillating mode, allowing a more effective attachment of the adenoma and faster morcellation at a rate of approximately 7.6 g/min.

After the procedure, the trocar was retrieved, and there was no need to close the skin orifice.

A cystostomy tube was not placed, and a 3-way indwelling urethral catheter was kept in place for bladder irrigation until the day after the procedure.

Conclusions:

This is a low-cost technique that can democratize the morcellation procedure and consequently, endoscopic prostatic enucleation, especially in developing countries. ⁹

In addition to serving as a backup strategy in case of damage to the main equipment for those who already have traditional morcellators and may be useful when enucleation is performed with small-caliber devices because supra pubic morcellation offers better visualization of the adenoma.

The author(s) declare that they have no commercial associations (e.g., consultancies, stock ownership, equity interests, patent/licensing arrangements, or other equity interests) that might pose a conflict of interest in connection with this video.

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.