Power Morcellator Features Affecting Tissue Spill in Gynecologic Laparoscopy: An In-Vitro Study

Lukas van den Haak; Ewout A Arkenbout; Evelien M Sandberg; Frank Willem Jansen

doi:10.1016/j.jmig.2015.09.014

Power Morcellator Features Affecting Tissue Spill in Gynecologic Laparoscopy: An In-Vitro Study

J Minim Invasive Gynecol. 2016 Jan;23(1):107-12. doi: 10.1016/j.jmig.2015.09.014. Epub 2015 Sep 30.

Authors

Lukas van den Haak¹, Ewout A Arkenbout², Evelien M Sandberg¹, Frank Willem Jansen³

Affiliations

¹ Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
² Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands.
³ Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands. Electronic address: f.w.jansen@lumc.nl.

PMID: 26432710
DOI: 10.1016/j.jmig.2015.09.014

Abstract

Study objective: To assess features of power morcellators (blade diameter, circular vs oscillating cutting, blade rotation speed, experience level) regarding their effect on the amount of tissue spill. In addition, the amount of tissue spill after the initial two-thirds and final one-third of the morcellated specimen was evaluated.

Design: In vitro study (Canadian Task Force classification II-2).

Setting: Laparoscopic skills lab of an academic hospital.

Patients: Not applicable.

Intervention: Power morcellation of beef tongue specimens.

Measurements and main results: Twenty-four trials were performed. Morcellation was performed in 2 phases (phase 1: initial two-thirds of the total tissue; phase 2: last one-third of the tissue). With larger blade diameter a decline was observed in both the weight of the spilled particles (phase 1) and the number of spilled particles (phases 1 and 2 and both combined) (weight phase 1: 6.5 g vs 6.3 g vs 2.2 g for 12.5 mm vs 15 mm vs 20 mm, respectively, p = .04; number particles: phase 1, 10.2 vs 7.2 vs 2.7, p = .01; phase 2, 22.9 vs 19.0 vs 8.9, p = .02; total, 34.7 vs 26.2 vs 11.6, p = .01). Also, spinning of the tissue mass due to torque applied by the rotating blade occurred later when blade size increased, and the size of the spilled particles was larger (weight of morcellated tissue at onset of torque: 136 g vs 198 g vs 222 g, p = .07; size: .6 g vs .9 g vs .8 g, p = .1). In the oscillation mode there was less total spill (6.8 g/100 g vs 21.3 g/100 g, p = .01, for oscillation and circular cutting, respectively).

Conclusion: The present study demonstrates that less spill is created by power morcellators with an oscillating blade and/or a large diameter (≥20 mm). Furthermore, when using a large-diameter blade the spilled particles are larger, and less morcellation repetitions are needed. By combining these features with currently introduced contained morcellation, the safety of the morcellation process with respect to tissue spill can be further improved.

Keywords: Laparoscopy; Morcellation; Myomas; Power morcellators; Sarcoma; Tissue spill.

MeSH terms

Animals
Cattle
Disease Models, Animal
Humans
In Vitro Techniques
Laparoscopy* / methods
Minimally Invasive Surgical Procedures*
Organ Size
Tongue / pathology*