Comparison of Morcellation Techniques at the Time of Laparoscopic Hysterectomy and Myomectomy

Abstract

Study ObjectiveTo compare perioperative outcomes associated with the use of 3 techniques for tissue removal at the time of laparoscopic hysterectomy and myomectomy. DesignA retrospective cohort study (Canadian Task Force classification II-2). SettingAn academic hospital in Boston, MA. PatientsWomen who underwent a laparoscopic or robot-assisted laparoscopic hysterectomy or myomectomy involving tissue morcellation in 2014. InterventionsOne of 3 morcellation techniques: electronic power morcellation (PM), manual vaginal morcellation via the vagina (VM), or manual morcellation via minilaparotomy (ML). Measurements and Main ResultsOf the 297 cases included in this study (137 myomectomies, 62 total laparoscopic hysterectomies, and 98 laparoscopic supracervical hysterectomies), 96% of the cases were performed by fellowship-trained surgeons using conventional laparoscopy. Containment bags were used at the time of tissue extraction in 77% of the cases. Baseline characteristics and perioperative outcomes were similar in all groups. In hysterectomy cases, the average specimen size was largest in the ML group (591 ± 419 g in the ML group compared with 368 ± 293 g in the PM group and 449 ± 175 g in the VM group, p = .0009). After multivariate regression, no significant difference was found in blood loss, length of stay, or complications. The operative time was shorter in the PM group compared with the ML group by 16 minutes (mean = 140 minutes [95% confidence interval, 130–149 minutes] compared with 156 [95% confidence interval, 146–167], p = .02); this association remained significant once additionally adjusting for the use or nonuse of containment bags (p = .05). ConclusionWe did not detect a significant difference between the 3 morcellation techniques when comparing the perioperative complications although the longest operative times were noted for the minilaparotomy approach. All 3 morcellation techniques represent viable options for tissue extraction at the time of minimally invasive surgery.