Uterine tissue extraction by morcellation: Techniques and clinical issues
- Elizabeth A Stewart, MD
Elizabeth A Stewart, MD
- Consultant and Professor of Obstetrics and Gynecology
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology
- Mayo Clinic and Mayo Medical School
- Section Editors
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
- Barbara Goff, MD
Barbara Goff, MD
- Section Editor — Gynecologic Oncology
- Professor of Gynecologic Oncology
- University of Washington
- Tommaso Falcone, MD, FRCSC, FACOG
Tommaso Falcone, MD, FRCSC, FACOG
- Section Editor — Minimally Invasive Gynecologic Surgery
- Professor of Obstetrics and Gynecology
- Cleveland Clinic Lerner College of Medicine
Gynecologic surgery often employs tissue extraction techniques to remove a large specimen (uterus or leiomyomas) through a small incision. A common tissue extraction technique is morcellation (cutting a specimen into small pieces). Initially, morcellation was performed using a scalpel at the time of vaginal procedures or laparotomy. As laparoscopic techniques were adopted, there was the advent of electro-mechanical morcellators (also referred to as electro-mechanical morcellators) that utilize rapidly rotating blades to quickly core and remove specimens during laparoscopic or robotic procedures. In 2014, concerns were raised that morcellation may disseminate tumor cells in cases in which an undiagnosed uterine malignancy was present. This prompted action by the US Food and Drug Administration, new guidelines for the use of electro-mechanical morcellators, and a decrease in use of these devices [1-6].
Uterine morcellation techniques are reviewed here. General principles of the treatment of leiomyomas are discussed separately. (See "Overview of treatment of uterine leiomyomas (fibroids)" and "Abdominal myomectomy" and "Laparoscopic myomectomy and other laparoscopic treatments for uterine leiomyomas (fibroids)".)
●Morcellation – Cutting tissue into small pieces. This is typically performed to remove a large tissue specimen through a small incision.
●Electro-mechanical morcellation – Morcellation of tissue with an electric device. This is usually used only in laparoscopic procedures.
●Scalpel morcellation – Morcellation of tissue using a scalpel. The specimen is cut into fewer pieces, and pieces are less likely to be distributed throughout the abdomen or left in the abdomen after surgery in contrast with electro-mechanical morcellation. In gynecologic surgery, this is typically done to remove a bulky uterine specimen during vaginal hysterectomy and sometimes during a myomectomy or hysterectomy through a minilaparotomy incision.
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- CLINICAL APPLICATIONS
- RISKS OF MORCELLATION
- Tissue dissemination and worsened prognosis
- - Uterine sarcoma
- - Leiomyoma variants
- - Endometrial carcinoma
- - Other conditions
- Surgical complications
- Power versus scalpel morcellation
- Other procedures
- POLICY STATEMENTS
- Government agencies
- Professional societies
- PREOPERATIVE EVALUATION
- Evaluation for uterine cancer
- Patient selection
- MORCELLATION DEVICES AND TECHNIQUES
- Power morcellation
- - Intraperitoneal
- - Containment systems
- Scalpel morcellation
- ALTERNATIVE TECHNIQUES
- SUMMARY AND RECOMMENDATIONS