Electrical prostate morcellator: an alternative to manual morcellation for laparoscopic nephrectomy specimens? An in vitro study.
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.
Cai
Yi
Y
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Jacobson
Avrum
A
Marcovich
Robert
R
Lowe
Daniel
D
El-Hakim
Assaad
A
Shah
Darshan K
DK
Smith
Arthur D
AD
Lee
Benjamin R
BR
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