2538 Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids

Abstract

Study Objective Since the 2014 Food and Drug Administration warnings regarding the use of power morcellation, gynecologists have adopted multiple alternative tissue extraction strategies. The objective of this study is to investigate the current techniques used by minimally invasive gynecologic surgeons for tissue extraction following minimally invasive hysterectomy for fibroids. Design Web-based survey. Setting N/a Patients or Participants Current AAGL members were sent a link to access the survey, which was available from March 26, 2019 to April 17, 2019. Interventions N/a. Measurements and Main Results 420 respondents completed the survey. The most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) and mini-laparotomy (66.9%). 31.7% of all participants endorsed the use of power morcellation. Intact specimen removal through a laparotomy was reported by 10% of respondents. Other methods of tissue extraction, such as intra-abdominal manual morcellation with a laparoscopic scalpel, were reported by 1.4%. Use of containment bags was reported by 43.4% during vaginal morcellation, 83.6% during mini-laparotomy, and 56.8% during power morcellation. Mini-laparotomies were on average 3.5cm and most commonly located at the umbilicus. Geographic differences were seen with respect to power morcellation, with 18.4% of US-based surgeons reporting its use compared to 56.9% of non-US-based surgeons. Conclusion Minimally invasive gynecologic surgeons are currently employing a variety of tissue extraction strategies for hysterectomy for fibroids. A large majority of practitioners are performing manual morcellation through the colpotomy and/or mini-laparotomy; use of containment bags is more common with during mini-laparotomy than via colpotomy. Power morcellation is still in use, less commonly in the United States than in other countries, and usually within a containment system.