Laparoscopic Power Morcellators: The Risks and Advances of Laparoscopic Morcellators
What are Laparoscopic Power Morcellators?
Laparoscopic power morcellators are surgical devices used to cut up and remove tissue through small incisions made during laparoscopic surgery. Power morcellators contain rotating blades or wires that pulverize tissues into smaller fragments to allow for extraction through a laparoscopic port site only a few centimeters in diameter. This enables surgeons to perform minimally invasive procedures such as hysterectomies and myomectomies through smaller incisions rather than traditional open surgery.
Morcellation Procedure
During a laparoscopic hysterectomy or myomectomy procedure involving morcellation, the surgeon initially laparoscopically dissects the uterus or fibroid from its attachments to surrounding structures. A port site is then expanded to accommodate the diameter of the Laparoscopic Power Morcellators, which is inserted through the incision in a protective bag or container. The surgeon uses the morcellator to mechanically cut the excised tissue into small pieces within the protection of the bag or container. The container helps collect and contain smaller tissue fragments during morcellation. The shredded tissue pieces can then be easily extracted from the body through the smaller port site incision without the need for a larger abdominal incision.
Risk of Spreading Occult Cancer
While morcellation enables surgeons to offer patients a minimally invasive alternative to traditional abdominal surgery, concerns have emerged regarding its oncologic safety when performed on patients who may have an undiagnosed uterine sarcoma or other occult gynecologic cancer. It is estimated that approximately 1 in 350 women undergoing a hysterectomy for presumed fibroids or other benign conditions are actually found to have an unsuspected uterine sarcoma. When morcellation is performed on tissue containing an undiagnosed sarcoma, it risks mechanically dispersing cancerous cells throughout the abdominal and pelvic cavities which can then implant and grow on peritoneal surfaces. This upstages the cancer and reduces survival rates compared to contained intrauterine disease. Some studies show morcellation of occult sarcomas may worsen prognosis up to 50%. This risk of “spilling the contents” led the FDA to issue warnings against the use of power morcellators for hysterectomy or myomectomy in most cases in 2014.
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