The Prostatic Punch Procedure
Originally introduced by Young in the USA
Various instruments in surgical history have been said to be the precursor of the prostatic punch.
Ambroise Paré, the 16th-century French surgeon, created an instrument (right) to trap and rip off the "carnosities" of the urethra (probably pieces of prostate). In the 19th century, Louis Auguste Mercier, also a Frenchman, introduced a "prostatome" for cutting through the median bar or bladder neck; used blind it was a bit like a lithotrite.
Derek Fawcett (BAUS Past-President) recalls his experience of the punch procedure:
I worked for Mr Laughton Leask, Consultant Surgeon at Kingston Hospital in 1977, when I was on the St Thomas' surgical registrar rotation. He routinely used the cold punch and was a master - an incredibly difficult instrument to use safely - frequently taking less than 10 bites. Between each one, he would pass the "bee sting" electrode under direct vision to try and control the bleeding. The patients needed washing out frequently - we used the Riches glass syringe - very disturbed nights! I have no recollection of how they fared in the long term.
It was Hugh Hampton Young who, in 1909, first used the name "punch" with his introduction of the cold punch method. Under vision, he used a urethroscope with a window cut in it; prostate tissue fell into the window as it was advanced, and an internal tubular blade was pushed forward and punched a piece of tissue out. This piece of prostate then had to be fished out of the bladder with forceps and as would be expected, it caused considerable bleeding.
The punch was more popular in America than in Britain or Europe, but some British surgeons did take it on.
In 1939, Walter Galbraith had the GU Manufacturing Company copy a Thompson Punch (pictured right). This instrument was subsequently improved by RHOB Robinson.
Punch prostatectomy film clips
This film shows a punch prostatectomy and was made in 1950, in Glasgow, for the Punch Club. It is a combination of film and cartoon, allowing you to "see" what the surgeon sees down the punch (in 1950, of course, there was no endoscopic video!).
The original cinefilm was converted to VHS and then digitised by Mr Mark Harrison who kindly sent it to The BAUS Museum. It has been broken up into clips of about 2 mins to allow it to be uploaded into the museum. The surgeon was Mr Tom Chapman of Hairmyres Hospital, East Kilbride (where a special unit was set up to carry out this procedure with the able assistance of a Polish refugee surgeon). The original film did have a soundtrack but this has been lost.
YouTube has, in its infinite wisdom, decreed that, because of
their comtent, two of these videos should be age-restricted 😳
Click on the YouTube link to view them directly
Part 1
An introduction to the equipment & technique
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Part 2
Resection of the median lobe
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Part 3
Use of the diathermy electrode
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Part 4
Resection of the right lateral lobe
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Part 5
Resection of the residual left lobe
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