Increased oscillation rate may improve morcellation efficiency in HoLEP.

Introduction: Tissue morcellation has become increasingly efficient, yet remains a rate limiting step in holmium enucleation of the prostate (HoLEP). Limited data exists on how the rate of oscillation by the morcellator blades affects morcellation efficiency (ME).

Methods: We undertook a retrospective review of HoLEP procedures performed by two surgeons from July 1, 2019 to August 25, 2022. All morcellation was performed with the Wolf Piranha device and enucleation was performed with Moses 2.0 technology. Surgeon 1 routinely uses 1500 oscillations/min (low rate [LR]) and Surgeon 2 uses a rate of 6000 oscillations/min (high rate [HR]). These rates were confirmed upon EMR review of each case. The primary endpoint was ME (g/minute). Secondary endpoints included enucleation efficiency (EE), mean tissue specimen weight, and preoperative prostate volume.

Results: A total of 894 HoLEPs were analyzed, 592 by Surgeon 1 and 302 by Surgeon 2. Surgeon 1 had larger preoperative prostate volumes (126 vs. 101, p<0.001) and specimen tissue weights (86.0 vs, 61.1, p<0.001). EE was higher in the LR group (1.67 vs. 1.33 g/min, p<0.001). Morcellation time was longer in the LR group (11.3 vs. 6.09 min, p<0.001) and ME was lower in the LR group (9.26 vs. 12.1 g/min, p<0.001). The difference in ME was inversely proportional to specimen weight.

Conclusions: Increased oscillation rate during morcellation may lead to decrease in morcellation time and increased ME during prostate enucleation. The primary limitation of this paper is the inclusion of only two surgeons. Future studies will serve to evaluate this finding across a larger number of institutions, and evaluate ways to increase ME in large prostate cohorts.