Browsing by Subject "HoLEP"

Now showing 1 - 5 of 5
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    Ex Vivo Comparison of Efficiency, Safety, and Surgeon Satisfaction in Four Commercial Morcellators
    (Mary Ann Liebert, 2021) Lee, Matthew S.; Assmus, Mark A.; Cooley, Lauren; Li, Eric; Large, Tim; Krambeck, Amy; Urology, School of Medicine
    Introduction Holmium Laser Enucleation of the Prostate (HoLEP) is a size-independent treatment option for the management of benign prostatic hypertrophy. While advancements in laser technology have led to clinical improvements in the enucleation portion of HoLEP, the morcellation aspect of HoLEP is often the rate-limiting step. We sought to compare efficiency and surgeon satisfaction in four commercial morcellators. Methods This was an ex vivo study comparing four commercial morcellators: the Wolf Piranha, the Lumenis VersaCut, the JenaSurgical MultiCut Solo, and the Hawk Morcellator. Four surgeons with significant experience performing HoLEPs participated. Surgeons tested each device to morcellate two different prostate models 1) morcellating as much microwave-cooked chicken breast in 10 minutes and 2) timed morcellation of bull testicles. Surgeons completed subjective surveys after each morcellator trial. Objective outcomes included: morcellation efficiency (g/min morcellated) and aspiration power (time to aspirate 1 L of saline). Means of continuous variables were compared using ANOVA. Categorical variables were compared using chi-square tests. Statistical analyses were performed using SAS 9.4 (2019). Results Comparing subjective outcomes, the Piranha was chosen as the safest morcellator (p=0.0058). The least safe morcellator was thought to be the MultiCut by 75% of surgeons (p=0.046). The Piranha was chosen as the most effective morcellator by 75% of surgeons (p=0.046). Comparing objective parameters between the morcellators, the Piranha had the fastest aspiration time (43.50±10.34 s, p=0.0116). There were no significant differences in morcellation efficiency when using chicken breast (p=0.3096). However, when comparing the morcellation efficiency using bull testicles, the Piranha had the highest efficiency at 39.68±3.57 g/min (p=0.0268). Conclusion In this ex-vivo study comparing four different commercially available morcellators, the Piranha had the highest aspiration power. No significant differences were found in morcellation efficiency using microwave-cooked chicken breast. The Piranha was felt to be the safest and most effective morcellator.
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    Outcomes of octogenarians undergoing holmium laser enucleation of prostate
    (Springer, 2022-07) Heiman, Joshua; Agarwal, Deepak; Komanapalli, Sarah; Nottingham, Charles; Large, Tim; Krambeck, Amy; Rivera, Marcelino; Urology, School of Medicine
    Purpose Holmium laser enucleation of prostate (HoLEP) is an effective surgical procedure in men with BPH. Due to the increase in the use of medical therapy for BPH related lower urinary symptoms more octogenarians are presenting in a delayed fashion with significant symptoms and urinary retention. We evaluate the feasibility and safety of octogenarians undergoing HoLEP. Methods We performed a retrospective review of HoLEPs at our institution from July 2018 to December 2019. Patients were stratified into two groups based on age: < 80 and ≥ 80. Results A total of 458 patients were identified, with 74 (16.2%) ≥ 80. In patients ≥ 80, prostate volume was higher (p < 0.0005), there was a higher rate of antiplatelet/anticoagulation (p = 0.029) use, and a lower rate of alpha-blocker use (p = 0.0016). As expected, ASA scores which correlate with increasing number of concomitant diseases were greater in the ≥ 80 cohort (p = 0.016). There was no significant difference in intraoperative complications (p = 0.14), 90 day complication (p = 0.34), readmission rates (p = 0.425) or emergency room visits between groups (p = 0.15). Conclusions Despite higher medical comorbidities and increased rates of anticoagulation in octogenarians, there is no increase in operative or postoperative complication rates. Age alone should not be used as exclusion criteria for HoLEP.
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    Predictors of Enucleation and Morcellation Time During Holmium Laser Enucleation of the Prostate.
    (Elsevier, 2015-08) Monn, M. Francesca; El Tayeb, Marawan; Bhojani, Naeem; Mellon, Matthew J.; Sloan, James C.; Boris, Ronald S.; Lingeman, James E.; Department of Urology, IU School of Medicine
    Objective To examine predictors of enucleation and morcellation times within a large cohort of men undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hypertrophy. Materials and Methods Preoperative, perioperative, and postoperative clinical characteristics were available from men treated with HoLEP between 1998 and 2013 at Indiana University Health Methodist Hospital. Stepwise linear regression was performed to determine clinical variables which are associated with enucleation and morcellation times. Results We identified 960 patients who underwent HoLEP. Average (range) enucleation time was 65.7 (11-245) minutes and morcellation time was 19.7 (3-260) minutes. History of anticoagulation was associated with a small decrease in enucleation time (P = .013) whereas increasing HoLEP specimen weight was associated with increasing enucleation time (P <.001). History of intermittent catheterization, urinary tract infections (UTI), presence of dense prostatic tissue (colloquially referred to as “beach balls”), and increasing specimen weight were associated with increasing morcellation time (P <.05 each). Having HoLEP performed by a less experienced urologist was associated with longer enucleation and morcellation times. Conclusion Prostate volume is significantly associated with increased enucleation and morcellation times during HoLEP. Additionally, history of UTI and clean intermittent catheterization (CIC) is associated with modest increases in enucleation and morcellation times. Dense enucleated prostate tissue significantly impacts the ability to morcellate effectively. Increasing surgeon experience can significantly improve both enucleation and morcellation efficiency.
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    Same Day Discharge Following Holmium Laser Enucleation in Patients Assessed to have Large Gland Prostates (≥175mL)
    (Liebert, 2021) Assmus, Mark A.; Large, Tim; Lee, Matthew S.; Agarwal, Deepak K.; Rivera, Marcelino E.; Krambeck, Amy E.; Urology, School of Medicine
    Background: Holmium laser enucleation of the prostate (HoLEP) is a highly effective and durable minimally invasive surgery for benign prostatic hyperplasia. Historically, alternative treatments for large glands (≥175mL) are associated with prolonged length of stay (LOS) and postoperative catheterization. However, advances in laser technology combined with surgical technique optimization have early evidence supporting same day discharge. We look to examine contemporary same day discharge outcomes for large glands. Materials & Methods: With IRB approval we queried our EMR and retrospective clinical registry to examine perioperative outcomes of large gland (≥175mL) prostates that underwent HoLEP with consideration for same day discharge. Results: From 12/10/2019 to 09/29/2020 we identified 55 patients with a preoperative prostate size ≥175mL (39 CT, 12 MRI, 4 TRUS), of which 45 were scheduled for same day discharge and 10 for admission. Mean preop prostate size was 229.9mL (range 175-535mL) and 36 (65.5%) were in urinary retention. Mean preop PSA was 8.58ng/mL, AUA Symptom Score 22.3, and Qmax 8.8mL/s. At 3 months postop follow up mean AUASS was 6.7, PSA 0.87ng/mL and Qmax 20.4mL/s. All comer same day discharge rate was 70% (38/55). Of patients planned for same day discharge 38/45 (84%) were successful. Average LOS for all patients was 11.8h with catheterization of 21.2h. When compared to 2010 published large gland outcomes, our current LOS represents a 220% reduction. Looking specifically at patients planned for same day discharge, average LOS and catheter duration was 8.8h and 17.0h, while LOS and catheter duration for patients planned for admission was 25.7h and 39.4h, respectively. Conclusions: We report the first outcomes of preoperatively planned same day discharge for HoLEP in large glands (≥175mL). A combination of technologic advances and optimization of technique have allowed for a safe adoption of same day discharge, providing additional advantages over alternative large gland treatments.
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    A Survey of Morcellator Preference and Cost Comparison of the Lumenis VersaCut and Wolf Piranha Morcellators
    (Elsevier, 2017) Rivera, Marcelino E.; Lingeman, James E.; Heinsimer, Kevin; York, Nadya E.; Krambeck, Amy E.; Urology, School of Medicine
    Objective To evaluate operating room (OR) costs associated with the 2 available morcellators in the United States in a matched cohort and to determine benign prostatic hyperplasia surgeon's morcellator preference. Materials and Methods Patients from 2013, the last year our institution exclusively used the VersaCut device, were matched 1:1 with the most recent patient cohort, utilizing the Wolf Piranha morcellator. Cost of morcellation including the expense of OR time and disposable instrument costs were calculated. A survey to the Endourological Society e-mail listserv was sent to determine morcellator preference. Results We identified 142 patients who underwent holmium laser enucleation of the prostate in 2013. When compared with the VersaCut group, morcellation efficiency (4.4 vs 7.0 g/min, P <.01) and expense of OR time ($1420.80 vs $992.21, P <.005) both favored the Piranha morcellator system even when the costs of disposable instruments were factored into the analysis ($1338.81 vs $1637.50, P <.05). A total of 126 urologists responded to the survey. Of these, 56 (44.5%) perform transurethral prostate enucleations, which included 48 (86%) holmium. More endourologists use the VersaCut (n = 33, 59%) than the Piranha (n = 24, 43%) morcellator. Qualities that impacted the preference of morcellator included the preferred device is safer, faster, easier to use, reusable, and less expensive. Conclusion We identified a significant improved efficiency and improved cost savings utilizing the Piranha morcellator even when controlling for disposable costs. Of the endourologists who responded to the survey, less than half perform transurethral enucleation. Morcellator preference is largely based on safety, efficiency, and ease of use, whereas cost and reusablility were of lesser importance.