Recommendations for Safe and Efficient Morcellation After Endoscopic Enucleation of the Prostate

Objective Background: After EEP (HoLEP, ThuLEP, GreenLEP or bipolar) the enucleated tissue is removed through a process of mechanical morcellation. Morcellation is the last, and very important, step in EEP procedures. It introduces additional time, and the possibility for complications exists. Although this is not a difficult procedure, it requires a learning curve that can pose a challenge for inexperienced surgeons. There are two types of morcellation systems: oscillating and reciprocating (depending on blade movement). Objective: To demonstrate tips and tricks for safe and efficient morcellation after EEP and to share our experience with the oscillating morcellation system. Material and Methods Four hundred and thirty-six patients were treated with green laser enucleation of the prostate by 3 surgeons with the en bloc technique between June 2013 and November 2016. After completing the enucleation procedure we removed the adenoma with an oscillating mechanical morcellator (Piranha, Richard Wolf, Germany). We have reported our experience (including the learning curve) and collected multiple videos exemplifying not only proper techniques for safe morcellation, but also possible problems and their solutions. The authors have compiled their collective experience to offer tips and tricks as well as a practical approach to trouble shooting and problem solving of the morcellation procedure. Results The median morcellation time was 5.00 minutes (3.00; 10.0) and the median morcellation efficiency was 11.0 g/min (7.70; 16.0). Complications included 2 cases of superficial bladder injuries and no bladder perforations. Conclusion Morcellation is a safe and appropriate procedure to remove the adenoma after endoscopic enucleation of the prostate. However, without taking proper precautions major complications can occur. This video serves as a guide for safe morcellation after EEP and also offers practical advice to help avoid the most common complications in this procedure.