title: Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens? An in vitro study.
abstract: OBJECTIVE
  To compare the safety and efficacy of morcellation with the electrical prostate morcellator (EPM) or manual morcellation of the kidney, using an internal view within the morcellation sac.
  
  
  METHODS
  Thirty porcine kidneys, mean renal mass 174.5 g, were divided into three groups of 10. All morcellations were performed inside the LapSac. Groups 1 and 2 underwent morcellation using the EPM, monitored inside the LapSac using the nephroscope and outside the LapSac with the laparoscope, respectively. Group 3 underwent manual morcellation with ring forceps. The groups were assessed for morcellation time, fragment size, and LapSac integrity.
  
  
  RESULTS
  In group 1, one pinhole perforation occurred; in group 2, nine perforations occurred (five large and four pinhole). No perforations occurred (P <0.001) in group 3 (manual morcellation). The mean morcellation time for groups 1 through 3 was, respectively, 86.9, 47.1, and 15.1 minutes (P <0.0001). The corresponding mean fragment size was 0.011, 0.015, and 1.36 g. The difference in mean fragment size was significantly different between the manual morcellation group and the EPM groups (P <0.001), but not between the two EPM groups (P = 0.12).
  
  
  CONCLUSIONS
  Manual morcellation was safe, fast, and superior to morcellation with the EPM monitored either inside or outside the LapSac. The high rate of LapSac perforation precludes the use of EPM after laparoscopic radical nephrectomy in the clinical forum.
authors.affiliation: Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Cai
authors.forename: Avrum
authors.initials: A
authors.lastname: Jacobson
authors.forename: Robert
authors.initials: R
authors.lastname: Marcovich
authors.forename: Daniel
authors.initials: D
authors.lastname: Lowe
authors.forename: Assaad
authors.initials: A
authors.lastname: El-Hakim
authors.forename: Darshan K
authors.initials: DK
authors.lastname: Shah
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Lee
mesh_terms: D000818:Animals; D004560:Electricity; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D013552:Swine; D016896:Treatment Outcome