Laparoscopic renal ablation: An in vitro comparison of currently availableelectrical tissue morcellators

Objectives. Morcellation with the Cook high-speed electrical laparoscopic ( HSEL) morcellator in an impermeable nylon/plastic sack (LapSac) has remaine d unchanged since its inception nearly one decade ago. Sack deployment and specimen entrapment remain relatively difficult, and morcellation with this device is expensive and relatively slow. As such, in an effort to facilita te specimen entrapment and morcellation, we adapted two currently available electrical morcellators (the Steiner gynecologic morcellator and the elect rical prostate morcellator [EPM]) for renal morcellation and compared them with the HSEL morcellator. Methods. All morcellation was performed through a simulated abdominal wall under direct laparoscopic vision. Ten porcine kidneys were ablated with eac h of the following techniques: HSEL morcellation in a LapSac; HSEL morcella tion in a fluid-filled LapSac; Steiner morcellation in an insufflated Endoc atch sack; and EPM morcellation in a fluid-filled Endocatch sack. A modifie d laparoscopic trocar was constructed and used for the Steiner and EPM morc ellation. The time to complete morcellation, morcellation product size, and entrapment sack integrity were evaluated for each technique. Cost data for each morcellator are also presented. Results. The mean morcellation time for the Steiner, HSEL dry, HSEL wet, an d EPM morcellation was 6.0, 15.9, 14.7, and 26.0 minutes, respectively. The mean fragment size for these morcellators was 2.97, 0.65, 0.62, and 0.013 g, respectively. A single entrapment sack perforation was documented in a L apSac during routine HSEL morcellation. Conclusions. Renal morcellation with all three morcellators is feasible. Th e Steiner morcellator combined with an Endocatch resulted in more rapid mor cellation and larger morcellation products. UROLOGY 56: 677-681, 2000. (C) 2000, Elsevier Science Inc.