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Uterine tissue extraction by morcellation: Techniques and clinical issues

Author
Elizabeth A Stewart, MD
Section Editors
Robert L Barbieri, MD
Barbara Goff, MD
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

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 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].

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)".)

TERMINOLOGY

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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Literature review current through: Nov 2016. | This topic last updated: Mon Sep 12 00:00:00 GMT+00:00 2016.
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