The Big Prostate by Veeru Kasivisvanathan & Ben Challacombe

Author:Veeru Kasivisvanathan & Ben Challacombe
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

7.3.2 Morcellation

Initial descriptions of Holmium resection of the prostate by Gilling and Fraundorfer involved the resection of tailored fragments of prostate that could be removed with the aid of either a modified resectoscope loop or Ellik evacuator [15]. The addition of mechanical morcellation of resected prostatic tissue, originally via a supra-pubic tract and later trans-urethrally, facilitated complete enucleation of the prostate. Holmium Laser Enucleation of the Prostate was thus truly conceived by Gilling and Fraundorfer with the addition of mechanical morcellation [16].

The mechanical morcellator consists of a hand-piece with 5-mm reciprocating blades (Fig. 7.3). Control is via a multiple staged foot control, which engages progressively from zero suction, suction, suction with low speed blade reciprocation and suction with high-speed blade reciprocation. This is passed down a long nephroscope which is connected to the 26F outer sheath by a specific adapter. Double inflow irrigation is recommended to ensure bladder distention during morcellation thus reducing the risk of bladder injury.

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