Electromechanical morcellators in minimally invasive gynecological surgery, an update.
J Minim Invasive Gynecol. 2014 Jan 21;
Authors: Driessen SR, Arkenbout EA, Thurkow AL, Jansen FW
OBJECTIVE: Since the introduction of minimally invasive surgery, various morcellators have been designed and used for gynecological surgery. The use of morcellators has become more important since the increase of laparoscopic removal of larger uteri and fibroids. This study compares all electromechanical morcellators used in the gynecological field to achieve an objective comparison between them and extract suggestions for improvements in future developments.
METHOD: The PubMed, Web of Science, EMBASE, MEDLINE and MAUDE databases were systematically searched for all available literature using the terms "morcellator", "morcellators", "morcellate", "morcellation" and "morcellated". All articles with information on morcellation time and morcellated tissue mass or the calculated morcellation rate of electromechanical morcellators used for gynecological laparoscopic surgery were included. For general data of an existing morcellator the manufacturer was contacted and Google was searched. The data were compared on morcellation rate, the type of procedure and general characteristics.
RESULTS: 7 articles were suitable for analysis and 11 different morcellators were found. In the last decades the morcellation rate has increased. The described morcellation rate ranged between 6.2 to 40.4 g/min. Motor peeling is currently the fastest working principle. Comparing hysterectomy and myomectomy per device, the Morcellex and Rotocut morcellators showed a higher morcellation rate for myomectomy (respectively 25.9 vs. 30 g/min and 28.4 vs. 33.1 g/min), although the X-tract morcellator showed a higher rate for hysterectomy (14.2 vs. 11.7 g/min).
CONCLUSION: Over the years, the morcellator has improved with respect to the morcellation rate. Yet the morcellation process still has its limitation, including tissue scattering, morcellator-related injuries and the inevitable small blade diameter, which all come at the expense of the morcellation rate and time. Therefore new developments of the morcellators are required and observed limitations should be considered for further improvements of the morcellator.
PMID: 24462590 [PubMed - as supplied by publisher]