Formación
An excellent presentation on Commercially Available Morcellators by Ivan Schwartzmann
Dr. Fernando Gómez Sancha · ICUA
Dr. Fernando Gómez Sancha · YouTube
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Sobre este vídeo
Presentación de Ivan Schwartzmann sobre los morceladores disponibles comercialmente, realizada en la reunión iLUTs de Madrid. La descripción sitúa al ponente en Fundació Puigvert, Barcelona, y explica que autorizó compartir la charla en el canal. El texto publicado no enumera los dispositivos ni sus resultados comparativos.
Recently, I attended the iLUTs meeting in Madrid and watched Ivan Schwartzmann's presentation on Commercially Available Morcellators. I liked it so much that I asked him if he would want to have it published in my channel and reach a large population of enucleators worldwide. He agreed. Ivan is a bright urologist devoted to BPH treatment, a world-class AEEP expert, and is also involved in teaching others. He is a brilliant speaker! Ivan works at Fundació Puigvert in Barcelona, Spain.
Datos documentados y fuentes
Solo datos expresos en las fuentes. Un dato ausente no implica que no ocurriera.
No se han extraído características clínicas de un caso para este vídeo.
Título y descripción originales en YouTubeFuente consultada: 2026-10-06.
Transcripción disponible · Inglés
Automatic YouTube captions, not clinically reviewed. Names, technical terms and numbers may contain errors. The available original caption track is English, whereas the YouTube audio-language metadata says Spanish; this discrepancy has not been resolved by listening to the audio.
Pueden contener errores de transcripción o traducción; verifica la explicación en el vídeo.
- hello I'm Dr Evan Schwartzman I'm a urologist with special dedication for BPH and I work at fundas in Barcelona Spain and I want to talk to you about morcellation and how to find the perfect melor for you if you're looking for one opinions of course are my own in this presentation I'm going to talk to you about some mation Basics and I'm going to do an evaluation of the available morcellators in Europe so let's talk with morcellator Basics the composition of a morcellator is quite complex morcellators are composed of many different pieces but most of them vary in one of two things in the blades and the suction system the blades can be oscillating moving from one side to the other or reciprocating moving from um
- the front to to the back and the suction mechanism can be one of three mainly one is a vacuum generator the other one is a peristaltic pump and the third potential one is to connect the mulat to the uh the suction in the O I really don't recommend this option because it's rarely strong enough to perform good morcellation so basically two vacuum pump or peristaltic pump vacuum generat peristaltic pump and I'm going to talk to you about the available Moors in Europe these are the six available mosat in Europe Main in the market right now we can divide them in two in the classic morcellators and the new morcellators and I'm going to perform an individual evaluation on each one of them based on a bit of my experience and
- the available um scientific evidence on them regarding specially efficiency grams per minute of mulation BL wall injury rates malfunction of the devices and attempt to evaluate also the price and I put all this information in this in this table would that would be available for you in the video notes let's start from the beginning the first available morcellator was the versacut developed by lumenis now owned by [ __ ] scientific it is the only um morcellator that exists now with reciprocating blades the outside is and the inside is sharp and this is the vers millor this is the first mulat mulat I tried one of the problems with this mulat is that since the blades are moving in inside it's difficult to see
- exactly where it is and if you get too close to the BL wall you can you can potentially injure them and that's what we observe in this in the available evidence very useful study this one by France and colleague the systematic review on Mor lers it showed it it um showed that there are 17 studies almost 3,000 patients on the versacut with a median efficiency of a bit under four grams per minute a blood wall injury rate above 5% and a very low divis malfunction rate at less than 1% we see here this Blood wall injury rate a bit High probably because of this oscillating of this reciprocating movement of the blades and regarding the price is this one of the cheapest melors available second available melor was a
- PNA from Richard Wolf the outset is sharp the inside is rough this is the pania functioning this is one of the two melat we currently have in my hospital is a very efficient very safe oscillator I really I really like it oscillating blades and a vacuum generator for the uh suction at the beginning we had a bit of problem with the with the vacuum generator we really don't have these problems anymore but we develop a a set of tips and tricks to use this mulat we will improve the seal on the tissue trap we would cut a bit of the tubing we make a tubing shorter so the vum would be more efficient and it's very important to make sure that this this rubber ring is correctly positioned inside the hand
- piece it can become this Lodge during especially during during sterilization and you have to reposition it if it's not in place like this this is a correct position it will not work properly also the recommended position of the blades is 50% open this also improves efficiency a little bit so whatever it is we have also a lot of evidence on this morat 13 studies more than two 2500 patients Medan efficiency rate higher than the verata 5.3 grams per minute BL will injury rate much lower at 1.2% and a device malfunction rate a bit higher at a bit over 2% and of course the price of this Moor is much more expensive than the than the vers in the higher range of price there are some studies comparing two Moors
- head-to-head verak P of course is are the ones with Mod evidence there five studies five head-to-head comparisons two of them so so show similar efficiency between them and three show that the PNA is more efficient I personally agree with the PNA being more efficient and also the PNA has Le less auxiliary procedures the third moror I'm going to talk about and this is one of the first one of the new morcellators is a drill cut developed by C shorts rough inside and outside it is an also an oscillating uh morcellator with a vacuum generator so very similar functioning to the to the PNA the plays are very different but the the the rest of the movement is is quite similar and now the available evidence drops dramatically
- only two studies available for the drill cut the median efficiency is very similar to the one observed in the Panna BL wall injury weight also very similar a bit over the 2.1% of the PNA but and this sends out for this moal device malfunction rate very high very high at almost 8% it's also on the higher end of the price range and one of the most interesting new mulat is definitely the multic cut the multic cut solo it can be attached to the G laser or by its own then is known as a multicut solo it has a very nice interface you can um modify the oscillation and modify the aspiration as well it will be why this is is useful this is especially useful when you are trying to mulate a very hard piece of Aroma you have to lower
- the speed of the blades a lot and when you do that then the most the the oscillating movement can become stuck and if you take away the mo the oscillation it just spins in One Direction and it's less um easy for the adenoma to get stuck so the outset is rough on the blades the inside is sharp it also has a more an oscillation this is a multicut solo functioning it has a very high speed of of Blade movement it is oscillating as every every every musul we've seen except the versut but it has a peristaltic pump like the versut so no vacuum generator and this makes the suction mechanism not as strong let's say there are some tips for improving this this um suction to improving a little bit what we do is
- with mulate suing up so we have the gravity helping us with the water falling from the from a higher position of the patient we compared to the the device and then to the to the drainage and to have a very good position not too far away from the BL wo to avoid a very sharp angle between the hand piece the hand the blades of the morat and the adenoma there are currently no published head-to-head comparisons there's no published evidence regarding the multicut but it will be soon because we perform a head-to-head comparison between multicut and PNA in a prospective randomized single Center study at fundas in 137 patients this is pending publication I hope this will be published soon and to our surprise the
- multicut was a new more later everyone talked about it but the PNA in our study is still more efficient globally and this efficiency is more pronounced in the bigger proc proes and less pronounced sorry more pronounced in the smaller proes and less pronounced in the bigger proes this might has have to do with the fact that we have a 2 liter Reservoir canister for the for the liquid for the PNA so we have to change it when we have bigger processs more often and this can slow down the process we also observed a higher BL W injury rate in the multicut compared to the pania and a lower malfunction rate this is probably due to the peristaltic pump it's a simple mechanism for suction and it it gets uh
- J it presents problems less often so it's less powerful but it works it it doesn't get it doesn't break that often might be a little bit um cheaper because you can reuse the blades so might be a little bit cheaper in this regard but it's not really a very cheap mulat one of the two last Moors I want to talk about is a Jaws developed by by the hawk company this is a Chinese company this is a a moscat very similar in functioning to the to the PNA also oscillating blades and and a vacuum generation generator there is some evidence available for this melat but not a lot the first study by by he and colleagues is not a study directed to morcellation but to an nucleation in general and they report a little bit
- their efficiency with the hog mulat and the other study available is by I IAL and colics and it's published in the not indexed uh Journal so two studies Med efficienc rate similar to PNA blood wall injury rate to 0% of device Mal function 0% but with not great level of evidence it's also on the higher end of the price range of course prices can vary dramatically between um countries and between hospitals and you have to negotiate the price for your was later this is just of course a guide and the last one I want to talk to you about is a cyber blade from the Quant systems this is this should get a price for design Innovation this one is a purely Innovative design everything is controlling the hand piece the outside
- is sharp the inside is rough no pedal for this millat only you canot you only need to connect the vacuum pump to of course drain the liquid and the and the prosthetic tissue so this is the Cyber blade and functioning this is how you increase or decrease the speed of the blades this is how you activate them this level activates the vacuum I would Define it as slow but steady with emphasis in slow only based in my personal experience I've tried it a couple of times not a lot of experience but in my opinion it is the the slowest mulation millor the evidence on this millor is sadly lacking let's hope I think this going to change in the future there's an Italian group about to publish their experience with
- cyber blade and this will probably change uh soon this is probably a good mulat for a low volume practice or to have a saaka mulat is cheaper but it's probably the slowest so very little evidence very little to put here at this table so we put all the data in this table and of course there's a huge variation of the available evidence basically following the the the the direction of this arrow that verat have a lot lot of available um evidence the rest of the modulators have very little so it's better to change the exact numbers to some categories regarding efficiency BL wall injury R andal function probably the slowest s the verat and the Cyber blade all the others might have similar efficiencies
- we observed that the p in our experience the pan is a little bit better but with no huge differences regarding BL wall injury rate probably the versat is the the worst the highest with the highest BL wall injury rate and regarding device malfunction with the available evidence probably drill cut is the worst one and now of course you can be with this information you're ready to go to Amazon wherever you shop for mosters and buy your mulation start happily mulating and nucleating in your hospital but a word of warning if you have learned something from from Titanic it's not only that two people could have fit perfectly in that in that that um door but that sometimes the Builders of a device the producers
- of the company that develops a machine tells us that it's it's going to work fine it's never going to break remember what they said about the Titanic God himself could not SN this ship and of course God could and an iceberg as well could SN this ship so the morcellator is a machine you can expect that it will malfunction it will break so I will add one category to this to this chart that is after sales service and of course you can have you will have to feel this yourself considering the relationship you have with the different companies offering offering the the different Morel lators so I want to fish finish with some quick take-home messages when evaluating uh morat consider efficiency safety reliability price but also after
- sale service and to put the classic moreles compared to the new ones in one slide this would probably be it except for the for the quanta cyberblade all new morcellators are based on the pirna design really just to mention that there hasn't been a true Revolution morcellators we hope there is one soon because morcellation is something that we um endoscopic nuclear eers are not a big fans of it's bit dangerous it's a bit too slow so let's hope this improve in the future of course the new Mor lators are very based on the Panna design but having said that it is good to have competition is good good to have options in the market it makes the the market more Dynamic and it probably benefits both patients and
- surgeons and this is it thank you very much for your attention thanks again to for for the invitation to participate thank you Dr Gomez sancha was uh a privileged being able to talk to all to all of you