Time Savings Using the Steiner Morcellator in Laparoscopic Myomectomy

A newly developed morcellator creates a new dimension in minimally invasive surgery

We compared the efficiency and safety of a newly developed morcellator with a conventional device for minimally invasive supracervical hysterectomy. The prospective, randomized parallel-group study was set in a department of obstetrics and gynecology within an Academic Teaching Hospital. Patients included 48 women; 20 treated with an existing laparoscopic morcellator (Group 1); 28 treated with newly developed laparoscopic morcellator (Group 2). The weight-adjusted dissection time was reduced significantly by more than half with the new morcellator (p <.01). Significantly fewer (p <.05) and longer pieces of tissue were removed with the new morcellator. The median weight of morcellated tissue in Group 1 was 120 g (range 35-450 g), and the median operating time to remove the morcellated tissue was 10 minutes (range 2-45 minutes). The corresponding figures in Group 2 were 110 g (range 50-320 g) and 4 minutes (range 0.5-12 minutes). No bladder or intestinal lesions or other iatrogenic organ damage was seen with either morcellator. None of the patients in either group had postoperative complications. All interventions were completed as planned in both groups, and none of the procedures had to be converted to an open operation. Adequate tissue for histologic analysis was obtained from all patients. We concluded that the newly developed morcellator is a safe and effective instrument for laparoscopic supracervical hysterectomy, offering a much shorter operation time for the removal of morcellated tissue than a conventional device and a low risk of injury to surrounding organs and tissue.

Laparoscopic Morcellator-Related Injuries

STUDY OBJECTIVE

To identify and summarize all electric morcellator-related injuries published in the medical literature.

DESIGN

Systematic review (Canadian Task Force classification II-2).

SETTING

Databases.

SUBJECTS

Articles on morcellator-related injuries published from 1992 through February 2002, plus additional sources of information.

INTERVENTION

Search of MEDLINE and referencing of the FDA device report database.

MEASUREMENTS AND MAIN RESULTS

We were unable to locate any references to morcellator-related visceral injuries in the medical literature. Of 17 cases identified from the FDA database, 3 were excluded based on the trivial nature of the event (e.g., instrument did not function). The remaining 14 visceral injuries were to small and large bowel (11), kidney (2), pancreas (1), and major vascular structures (3). Identification of the complication was immediate in 10 patients, but was not until 4 days postoperatively in 1 woman. Three patients died. No device manufacturer or surgical specialty was responsible for a preponderance of the injuries.

CONCLUSION

These potentially fatal complications are unreported in the medical literature.

Laparoscopic supracervical hysterectomy with a new disposable morcellator

Laparoscopic supracervical hysterectomy (LSH) can be performed more easily with a powered morcellator for removal of the uterus. Available laparoscopic morcellators are expensive and may be difficult to use, but a new, powered, disposable instrument was developed (Diva; FemRx, Sunnyvale, CA) to morcellate the entire uterus for easy removal through a 15-mm cannula. Twelve consecutive women for whom subtotal hysterectomy was indicated underwent LSH by standard laparoscopic protocol and were monitored postoperatively for a minimum of 1 month. In the current trend of "less is more," LSH is an emerging option for less extensive hysterectomies and can be made more cost and time effective with a single-use powered morcellator.