Laser enucleation of the prostate (LEP) has become the gold standard for treating benign prostatic hyperplasia (BPH) with large glands. Morcellation, a crucial step in LEP, facilitates rapid tissue removal, thereby reducing operative time. Studies have quoted morcellation speeds of 4 to 6g of tissue removed per minute. When choosing between single-use or reusable morcellator blades, efficiency must be considered. Single-use blades are generally favored for their superior efficiency. This study aims to evaluate the performance of reusable blades and determine whether single-use blades are necessary.

This was a retrospective study of 55 cases of LEP performed from March 2024 to March 2025 in a large tertiary centre in Singapore. Enucleation was performed using either a pulse-modulated Holmium:YAG or pulsed Thulium:YAG laser. The Hawk Morcellator system (Hangzhou HAWK Optical Electronic Instruments Co., Ltd, Zhejiang, China) was utilized and connected to a suction system with a tissue trap. Morcellation data, including aspirated tissue weight and morcellation time, were recorded for each case. Morcellation efficiency (grams/minute) was calculated and analyzed using mixed effects models to assess the impact of accumulated blade usage, morcellation time and tissue weight.

10 blades were utilized over a total 55 cases. The mean morcellation efficiency across all the cases was 5.39g/min(SD=1.74), mean accumulated weight was 310.5g (SD=127.38), mean accumulated time 65.5min (SD= 26.95), and mean number of cases was 5.5 uses(SD=2.51). The most reuses in our study was 10 and only 1 of the blades was deemed blunt and disposed by the surgeon by the end of this study. Mixed effects modelling did not show any statistically significant effect (p>0.05) of accumulated weight, accumulated time or number of cases on morcellation efficiency, suggesting that blade efficiency is preserved even with repeated uses in our study.

While single-use morcellator blades may offer superior morcellation efficiency, reusable blades, in the Hawk Morcellator system, provide a sustainable advantage and potentially greater cost-effectiveness. Our study has shown that blade efficiency is preserved with repeated usage even up to 10 reuses . By further maximizing the durability of the Hawk system instead of disposing of reusable blades, health systems can support sustainability initiatives in surgical practice. Morcellation generally makes up a small portion of the time needed during LEP and it is the authors opinion that the use of a single use blade to marginally decrease total operative time may not justify the additional costs involved. However to draw more definitive conclusions about the relative merits of these options, further research with larger datasets and standardized conditions are necessary.