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홀미움 레이저 전립선 절제술 시 complicated situations에서 공기방광을 이용한 morcellation 방법 |
| 고려대학교 의과대학 안산병원 비뇨의학과 |
| 태범식, 전병조, 최훈, 박재영, 배재현 |
Objectives: To describe our initial experience with a novel method of adenoma retrieval using a pneumovesicum after Holmium laser enucleation of the prostate.
Patients and Methods: After enucleation of the prostate, the bladder was filled with saline or CO2 under cystoscopy. An 11-mm laparoscopic bladeless port was inserted at 2 cm from the pubic symphysis under cystoscopic guidance, and the bladder was inflated with CO2 while draining the saline. After establishing the pneumovesicum, the resected adenoma was grabbed using a pair of toothed forceps through a laparoscopic morcellator (Lina Medical, XciseTM), which is commonly used in gynecology. After morcellation, the bladder was closed using a 2-0 absorbable suture before draining the CO2.
Results: Twenty-one patients with a mean age of 67.3 years (standard deviation, ±5.6 years) were included in our analysis. The mean IPSS score, QoL, prostate volume, and enucleated prostate weight were 26.37 (range, 12.00-35.00), 4.94 (range, 3.00-6.00), 107.0±18.8 g, and 65.5±14.0 g, respectively. In addition, the mean total operation time and morcellation time were 125.9±38.0 min and 6.1±1.2 min, respectively. The enucleation efficiency was 0.86 g/min (range, 0.50-1.25 g/min) and the retrieval efficiency was 11.4±3.2 g/min. There were some cases of procedure-related complications, including post-operative extravesical leakage (5th case), clot retention (8th case), and re-catheterization (9th case).
Conclusion: This method has higher morcellation efficacy with an advantage of excellent visibility as compared to known conventional morcellation. The current method can be applied when a transurethral morcellator is out of order or cannot be used.
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keywords : Prostate hyperplasia, Holmium, morcellation |
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