The Use of the Harmonic Wave Scalpel ® to Reduce Intraoperative Bleeding During Open (Millin's) Prostatectomy: Single-Surgeon Series with Technique

Aim:

To describe our experience with the use of the Harmonic Wave Scalpel^® during open prostatectomy to reduce the risk of intraoperative bleeding.

Patients and Methods:

From May 2007 to February 2010, 19 male patients underwent an open (Millin's) prostatectomy using the Harmonic Wave Scalpel by the senior author. The mean size of the prostatic adenoma at the time of surgery was 113 cm³ (range 83–400) and the mean preoperative hemoglobin was 14.1 g/dL (range 12.0–15.8).

Results:

The mean intraoperative blood loss was 861.1 mL (range 350–2500). Twenty-six percent (5/19) patients required a blood transfusion (intraoperative and postoperative). The rate of blood transfusion before the introduction of this technique was 45% (9/20) in our previous series. None of the patients required an emergency laparotomy. The mean postoperative hemoglobin was 11.2 g/dL (range 10.7–14). The mean pathological weight of the retrieved adenoma was 139 g (range 83–352). In the video we describe our technique of the application of the harmonic scalpel to the prostate capsule, a technique used to control hemostasis and prevent intraoperative bleeding. In addition, this technique, in our experience, reduces the chance of a patient requiring an intra/postoperative blood transfusion and enhances an early discharge after open prostatectomy. Although there are techniques such as greenlight laser prostatectomy and holmium laser enucleation of the prostate (HoLEP) available and expertise continues to be developed, we currently offer an open (Millins) prostatectomy in patients with a prostatic gland volume >80 cm³. However, with the development of surgical experience and expertise, both green light laser prostatectomy and HoLEP will be offered to patients with larger adenomas, that is, between 80 and 100 cm³ in due.

Conclusion:

A safe and efficacious technique to reduced intraoperative bleeding during open (Millin's) prostatectomy. Our improving results with the technique are very promising; however, larger patient numbers are required to validate this further.

No competing financial interests exist.

Runtime of video: 10 mins