1188 Manual Tissue Extraction: Approach to Vaginal Morcellation

Abstract

Video Objective Vaginal morcellation is a manual tissue extraction technique used to remove large specimens following robotic, laparoscopic, or vaginal hysterectomy. The objective of this video is to present the technique and required equipment for performing vaginal morcellation following laparoscopic hysterectomy. Setting The case presented is of a 42yo G3P3 woman who presented with fibroid-related abnormal uterine bleeding and a 14-16 week size uterus, with minimal descent. Ultrasound described a multi-fibroid uterus with a normal adnexa. Recent pap smear and endometrial biopsy were normal. Following appropriate counselling, she underwent a total laparoscopic hysterectomy, bilateral salpingectomy, cystoscopy and subsequent vaginal morcellation of the uterine specimen. Interventions We demonstrate a safe and effective vaginal morcellation technique performed with bisection of the uterus, sequential anterior and posterior wedge resections and myomectomy. Conclusion Vaginal morcellation is a safe and feasible technique for manual tissue extraction in the well-selected patient. This procedure allows the surgeon to continue offering minimally invasive options to select patient populations and circumvents the need for laparotomy for specimen extraction. In recent years, there have been concerns regarding morcellation and the potential for inadvertent dissemination of malignant tissue. However, with appropriate patient selection, thorough pre-operative evaluation and careful surgical technique, the risks are low.