Optimal settings for the Cyber Blade morcellator system for holmium laser enucleation of the prostate (HoLEP): a preclinical study

BACKGROUND: Holmium laser enucleation of the prostate (HoLEP) is the emerged standard treatment modality for patients taking anticoagulants or with big prostatic adenoma. The procedure consists of two steps; enucleation of the prostatic adenoma and morcellation of the tissue. The morcellator parameters may affect the procedure’s efficiency and the risk of bladder trauma. The aim of our study was to assess the optimal settings of the Cyber Blade morcellator using an in vitro standardized experimental configuration.METHODS: We used an ex-vivo experimental model with raw bovine heart. We used a plastic container filled of saline 0.9% and a 26-Fr continuous irrigation sheath with a 5-mm working channel. We tested the morcellation rates (g/min) of the Cyber Blade Morcellator (Quanta System, Samarate, Varese, Italy) with the Medela Fluid Management System dominant 50 (Medela AG, Baar, Switzerland). We tested the speeds named as 1, 3, 5 and 7 by the manufacturer using the suction device at mid vacuum and flow during 3 minutes. Morcellation rates defined as the difference between initial and final weight were calculated. Median values of three independent measurements were assessed.RESULTS: Morcellation settings impacted the morcellation rate. Median weight differences for the tested speeds 1, 3, 5 and 7 were 8 g, 11 g, 6 g, and 5 g respectively.CONCLUSIONS: According to our experiments, morcellation settings have an impact on morcellation rate using the Quanta Cyber Blade morcellator. Speed 3 lead to a higher ablation rate compared to speeds 1, 5 and 7. Further clinical studies would be needed to confirm our findings.