Comparison of the efficiency and complications of lumenis and wolf morcellators after holmium laser enucleation of the prostate

Abstract

Introduction:Holmium laser enucleation of the prostate (HoLEP) is a recognized option for the surgical management of benign prostatic hyperplasia. While the laser parameters and enucleation techniques have been widely studied, the morcellation techniques still remain under-evaluated. The current study evaluates the two commonly used morcellation devices for their in vivo efficiency and patient safety.Materials and Methods:A total of 222 patients who underwent HoLEP at two medical centres between January 2011 to December 2013 by a single surgeon were included. Of these 222 patients, the Richard Wolf Piranha Morcellation System, Germany (WM), was used on 140 patients, while on the remaining 82, the Lumenis® VersaCut™ Morcellator, Yokneam, Israel (LM), was used. These devices were compared for safety parameters such as the incidence of bladder mucosal injury, deep muscle injury, bladder perforation, and bleeding requiring electrocoagulation. The morcellation efficiency (ME) defined as the ratio of the weight of morcellated tissue in grams to the time required for morcellation in minutes was also compared.Results:The incidence of bladder mucosal injury, deep muscle injury, and bleeding requiring electrocoagulation was statistically significantly lower for the WM than the LM. None of the patients had a full-thickness bladder perforation with either of the morcellators. The ME was higher for the LM. In eight patients, hard, smooth rounded adenomatous nodules could not be morcellated by the WM and had to be crushed by a stone grasping forceps before morcellation.Conclusions:While the LM is a faster morcellator, WM has a better safety profile.

Laser Aided Ceramic Restoration Removal: A Comprehensive Review

“…All ceramic restorations are esthetically advantageous and are increasingly used for both anterior and posterior restorations. 1 Laminate veneers have many indications to improve esthetics such as discoloration, hypocalcification, peg lateral teeth, fluorosis, 2 fractured teeth and diastema. 3 The longevity of these restorations is limited by caries around the margins, discoloration, microleakage of the resin cement and marginal fracture of restorations.…”

Hawk® JAWS versus Lumenis® VersaCut prostate morcellation devices: A comparative study and comprehensive literature review

“…In a randomized prospective study by El Tayeb et al, the morcellation efficiency of Piranha was higher than that of VersaCut; however, the difference was not statistically significant (22). In contrast to these studies, VersaCut had a shorter morcellation time (9.8 min vs. 14.5 min) and higher morcellation efficiency than Piranha (8.4 g/ min vs. 4.7 g/min) in another study (17). In a study comparing the efficiency and reliability of DrillCut and VersaCut morcellators, there was no significant difference between their morcellation times; however, it was found that the efficiency of VersaCut morcellator was significantly higher (3.6 vs. 4.9 g/min; p= 0.03) (20).…”

“…In the morcellation step, the last step of HoLEP, free prostate tissue pushed into the bladder following enucleation is taken out in small pieces. The tissue morcellators used in this pro- cess are designed to perform suction (aspiration) and tissue cutting (8,17). The suction removes the morcellated tissues out of the bladder while keeping the tissue close to the blade, and the movable blade of the morcellator breaks the prostatic adenoma tissue into small fragments.…”

Complications of anatomical endoscopic enucleation of the prostate

“…Therefore, effective haemostasis before morcellation and adequate bladder perfusion during morcellation to maintain bladder filling is of vital importance to prevent bladder injury during AEEP. Interestingly, Maheshwari Wagaskar and Maheshwari () explored whether morcellation devices played a role in the occurrence of complication, and eventually, they found that deep muscle or bladder mucosal impairment was significantly more common for reciprocating morcellators compared with oscillating morcellators. A small amount of flushing fluid extravasation owing to intra‐operative bladder injury is more frequent with no need of further treatment.…”