Landman Jaime, Venkatesh Ramakrishna, Kibel Adam, Vanlangendonck Richard
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Urology. 2003 Oct;62(4):632-4; discussion 635. doi: 10.1016/s0090-4295(03)00680-0.
To present our modified technique to expedite the entrapment and morcellation process. Standard renal morcellation is typically performed using a 12-mm incision, with the specimen entrapped within a durable LapSac. Because the LapSac does not have a deployment mechanism, its application is technically demanding and time consuming. The recent elimination of the electrical morcellator has also made the morcellation process time consuming and tedious.
Using an in vitro porcine kidney morcellation model, we compared traditional morcellation (n = 10) with our modified morcellation technique (n = 10). The modified morcellation technique incorporated an EndoCatch entrapment sac and used standard manual morcellation through a 3-cm incision. The 3-cm incision allowed for extracorporeal morcellation, because the specimen could be seen through the abdominal wall defect. Subsequently, we performed 11 laparoscopic radical/total nephrectomies for renal masses using the modified morcellation technique through a 3-cm incision.
In this in vitro model, renal specimen morcellation with the standard technique required a mean of 9.4 minutes (16.5 g/min) and modified morcellation required 3.24 minutes (51.24 g/min; P <0.0001). The mean fragment size with standard and modified morcellation was 1.47 and 4.46 g, respectively (P <0.0001). EndoCatch entrapment sack integrity was confirmed in all 10 cases (100%). Clinically, 12 patients underwent modified morcellation of radical nephrectomy specimens. All specimens were renal cell carcinoma, with a mean specimen weight of 724 g. The mean entrapment time was 2 minutes, 40 seconds, and the mean morcellation time was 11 minutes. EndoCatch entrapment sack integrity was confirmed in all cases. At a mean follow-up of 8 months, no trocar site or local recurrences have developed.
Preliminary laboratory and clinical data have demonstrated that the modified morcellation technique is safe and expeditious. The larger fragments that result from the modified technique may facilitate tumor staging. The technique must be performed with great care to prevent sack perforation. Prospective randomized comparison of the modified and standard morcellation techniques and long-term follow-up are required before routine application of this technique.
介绍我们改良的技术以加快组织捕获及粉碎过程。标准的肾脏粉碎术通常通过一个12毫米的切口进行，标本被捕获在一个耐用的LapSac内。由于LapSac没有展开机制，其应用在技术上要求较高且耗时。最近电动粉碎器的停用也使得粉碎过程既耗时又乏味。
使用体外猪肾粉碎模型，我们将传统粉碎术（n = 10）与改良粉碎技术（n = 10）进行比较。改良粉碎技术采用EndoCatch捕获袋，并通过一个3厘米的切口进行标准的手动粉碎。3厘米的切口允许进行体外粉碎，因为可以透过腹壁缺损看到标本。随后，我们通过一个3厘米的切口，使用改良粉碎技术对11例肾肿块患者进行了腹腔镜根治性/全肾切除术。
在这个体外模型中，标准技术进行肾脏标本粉碎平均需要9.4分钟（16.5克/分钟），改良粉碎需要3.24分钟（51.24克/分钟；P <0.0001）。标准粉碎和改良粉碎的平均碎片大小分别为1.47克和4.46克（P <0.0001）。所有10例（100%）的EndoCatch捕获袋完整性均得到确认。临床上，12例患者接受了根治性肾切除标本的改良粉碎。所有标本均为肾细胞癌，标本平均重量为724克。平均捕获时间为2分40秒，平均粉碎时间为11分钟。所有病例的EndoCatch捕获袋完整性均得到确认。平均随访8个月时，未出现穿刺部位或局部复发。
初步的实验室和临床数据表明，改良粉碎技术安全且迅速。改良技术产生的较大碎片可能有助于肿瘤分期。该技术必须非常小心地进行以防止袋子穿孔。在常规应用该技术之前，需要对改良和标准粉碎技术进行前瞻性随机比较并进行长期随访。
