The "Wedge" resection device for electrosurgical transurethral prostatectomy.

The "Wedge" (Microvasive, Natick MA) is a new electroresection device for transurethral prostatectomy (TURP) using the standard resectoscope. The design, which is broader than the standard loop and thickens from front to back, results in better hemostasis when used at 275 to 300 W because of its ability to cut and coagulate tissue simultaneously. In the canine model, histologic examination demonstrated a 2-mm zone of coagulation around the chips and in the resection bed; this response was not observed in the specimens resected by the standard tungsten loop. No adjacent tissue damage was found with either the Wedge or the loop, and the temperatures recorded at the capsule rose only 4 degrees C regardless of the device used. In the 65 patients treated, the average hematocrit drop on postoperative Day 1 was 3.0%, and serum sodium was unchanged. One year postoperatively, the peak flow rate had increased by 101%, and the AUA Symptom Score was 6.1. The only surgical complication was urethral strictures (3%) necessitating incision. Most striking was the increased case of resection attributable to improved intraoperative vision. The data suggest that Wedge TURP is as safe and efficacious as standard loop TURP. The surgical field is markedly improved and clear because of intraoperative hemostasis. A TURP can be performed with a view toward minimizing patient morbidity and increasing surgical ease.