Morcellation complications: From direct trauma to inoculation. (August 2016)

• Record Type: Journal Article
• Authors: Noel, Nyia L.; Isaacson, Keith B.
• Is Part Of: Best practice & research. Volume 35(2016:Aug.)
• Page Start: 37
• Page End: 43
• Publication Date: 2016-08
• Subjects: morcellation -- contained -- vaginal -- knife -- dissemination -- sarcoma; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2015.12.002
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract : Morcellation is the fragmentation of tissue to facilitate removal of the specimen through small incision in minimally invasive surgery. This technique is not unique to gynecology and is used in general surgery with the goal of improved surgical outcomes including decreased pain, cost, hospital length of stay, and rapid return to normal activities and work. Gynecologic laparoscopic power morcellation (LPM) has come under increased scrutiny over the last 2 years due to widespread attention to a known but rare complication, an unanticipated dissemination of malignancy, namely occult uterine leiomyosarcoma. This chapter focuses on complications associated with gynecologic tissue morcellation from inoculation of benign or malignant tissue fragments within the peritoneal cavity and direct trauma from morcellation techniques. We also include a review of the various morcellation techniques from knife to electrical and the use of intraperitoneal specimen containment systems. Highlights: Morcellation is the fragmentation of tissue to facilitate removal of the specimen. Morcellation can be performed with a knife or an electric mechanical morcellator. Morcellated specimens can be removed through the vagina, laparoscopic ports, or minilaparotomy. Morcellation within a specimen bag can aid removal and contain tissue fragments. The risk of occult leiomyosarcoma ranges from 1/352 to 1/8300[1] .