Development and evaluation of a novel endoscopic sack to facilitate tissue prostate adenoma morcellation.

INTRODUCTION: Morcellation of the adenoma after laser enucleation of the prostate (LEP) is both time consuming and prone to complications. We have designed a novel polyethylene sack (ProSac) to improve the morcellation process following LEP. A silicone and cadaver model were both utilized to evaluate safety and efficacy of the ProSac.

METHODS: The inanimate model used tissue-mimicking silicone to accurately approximates bladder volume and compliance. The second model was developed using a fresh cadaver. Heat-fixed chicken breast was used to mimic enucleated prostatic adenoma. Morcellation of the simulated adenoma tissue was tested in both models with and without the ProSac. Morcellated tissue was removed from the filter, desiccated, and weighed after each run to establish morcellation efficiency. Visual inspection was used to evaluate for mucosal injury or bladder perforation. A hydro-manometer was placed in the cadaveric bladder to measure bladder pressure.

RESULTS: The device was able to capture up to 30 grams of tissue with good closure while maintaining good distention and visualization during morcellation. In the silicone model, morcellation efficiency with the device was 4.6 g/minute, while efficiency without the device was 2.6 g/min (p = 0.03). In the cadaveric model, mean entrapment time was 22 ± 11 seconds. Morcellation efficiency with the device was 2.1 g/minute when excluding entrapment time and 1.9 g/min including entrapment time. Without the ProSac, morcellation efficiency was 1.2 g/min (p = 0.05). In both models, multiple mucosal injuries occurred without the device, while none occurred with the device. Bladder pressure was similar between study arms.

CONCLUSIONS: The ProSac is a novel device that can provide additional safety during adenoma morcellation. It may also achieve clinically and statistically significant improvement in morcellation efficiency without increasing bladder pressure.