Uterine Morcellation in Pelvic Organ Prolapse Procedures

Abstract

Electromechanical, or power, morcellators have come under scrutiny because of the iatrogenic dissemination of both benign and malignant tissues. The rapidly rotating blade of morcellators can result in inadvertent seeding of the abdominal cavity with fragmented tissue such as leiomyomas, endometriosis, adenomyosis, splenic and ovarian tissues, and occult malignancies. Of particular concern is the dissemination of unsuspected uterine cancers that may not be diagnosed through preoperative screening. Alternatives to power morcellation for tissue extraction include removal through the vagina and through minilaparotomy. Morcellation within a containment bag is another option to minimize the risk of iatrogenic tissue seeding. Preoperative screening for detectable malignancies should be performed. Surgeons performing morcellation during concomitant procedures for pelvic organ prolapse should be aware of the potential risks, benefits, and alternatives to morcellation and should discuss them with their patients.