Development and Evaluation of a Novel Endoscopic Sack to Facilitate Tissue Prostate Adenoma Morcellation
Autor: | Jeffrey Gahan, Heather Beardsley, Igor Sorokin, Brett A. Johnson, Jeffrey A. Cadeddu |
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Rok vydání: | 2018 |
Předmět: |
Adenoma
Male medicine.medical_specialty Urology Urinary Bladder education Enucleation Prostatic Hyperplasia Silicones 030232 urology & nephrology Morcellation Models Biological 03 medical and health sciences 0302 clinical medicine Laser therapy Prostate Cadaver medicine Animals Humans Urinary bladder medicine.diagnostic_test business.industry Prostatic Neoplasms Endoscopy Prostate Adenoma Equipment Design medicine.disease Surgery medicine.anatomical_structure Sack Polyethylene 030220 oncology & carcinogenesis Urologic Surgical Procedures Laser Therapy Patient Safety business Chickens hormones hormone substitutes and hormone antagonists |
Zdroj: | Journal of Endourology. 32:1136-1141 |
ISSN: | 1557-900X 0892-7790 |
Popis: | 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. Both silicone and cadaver models were utilized to evaluate the safety and efficacy of ProSac.The inanimate model used tissue-mimicking silicone to accurately approximate 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 hydromanometer was placed in the cadaveric bladder to measure bladder pressure.The device was able to capture up to 30 g 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/minute (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/minute including entrapment time. Without the ProSac, morcellation efficiency was 1.2 g/minute (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.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. |
Databáze: | OpenAIRE |
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