1. Morcellation Techniques for Laparoscopic Hysterectomy and Myomectomy: A Retrospective Study Elsemieke Meurs, BSc Mobolaji Ajao, MD, Luiz Gustavo Brito, MD PhD, Jon Ivar Einarsson, MD, PhD, MPH, Sarah L. Cohen, MD, MPH Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts
Objective
To compare the perioperative characteristics and recovery profiles of the varying approaches to minimally invasive specimen retrieval used during hysterectomies and myomectomies performed in 2014 including power morcellation, minilaparotomy, and vaginal extraction with knife morcellation.
Measurements & Main results, continued
Two-hundred and ninety-seven women were included in the analysis (62 TLH, 98 LSH, 137 LM). No significant differences were seen among the groups with regard to age, race, BMI or prior surgeries. After adjusting for baseline factors, there was no significant difference with regard to mean total operative time (141, 95% CI=131,150; 159, 95% CI=138,180 and 150, 95% CI=139,161 minutes, respectively for power morcellation, vaginal morcellation and minilaparotomy morcellation) or length of stay. Women who received vaginal morcellation, were twice as likely to have a complication compared to those who had power morcellation, though the association was not significant (OR=2.10, 95% CI=0.42, 10.4). There was a three-fold increase in the odds for a complication in the minilaparotomy group (OR=3.05, 95% CI=1.04, 8.99) compared to the power morcellation group. Although not statistically significant, the minilaparotomy group had a higher mean time for morcellation (52.44min ±19.07) than both the vaginal morcellation group (50min ±17.32) and the power morcellation group (32.71min ±27.26), (P=0.09).
Table 1- Description of cases of death
Fig 1- Indication for surgery and route of extraction
Power
Vaginal
Minilap
p-value*
N=146
N=33
N=118
N (%)
OR time
Mean (SD)
141.3 (62.28)
148.4 (59.68)
152.2 (72.04)
0.41
Time for morcellation procedure
32.71 (27.26)
50.00 (17.32)
52.44 (19.07)
0.09
EBL
139.9 (178.9)
72.58 (52.93)
150.8 (260.6)
0.31
Median (min-max)
75.0 ( )
50.0 ( )
100.0 ( )
Intraoperative complications
2 (1.4%)
1 (3.0%)
5 (4.2%)
0.36
Bowel injury
0 (0%)
Bladder injury
3 (2.6%)
0.57
Transfusion
1 (3.1%)
3 (2.5%)
0.72
Conversion
Readmission
1 (3.4%)
7 (6.0%)
0.13
Reoperation
2 (1.7%)
0.74
Length of stay
0.21 (0.50)
0.21 (0.42)
0.19 (0.57)
0.64
0.0 (0 - 3)
0.0 (0 - 1)
0.0 (0 - 4)
Methods
A retrospective analysis was performed on a cohort of all women who underwent minimally invasive hysterectomy or myomectomy for benign disease at a tertiary care academic hospital in The three specimen retrieval techniques which were compared include: power morcellation (both with and without the use of a containment bag), manual morcellation via minilaparotomy and manual morcellation via colpotomy. Total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy (LSH) and laparoscopic myomectomy (LM) were performed in standard fashion. Data recorded and analyzed include type of morcellation, size of minilaparotomy incision, use of containment bag, operative time, estimated blood loss, time for morcellation, length of hospital stay and intra- or postoperative complications. Patient characteristics and surgical outcomes between treatment groups were compared using Chi-square and ANOVA tests. In addition, multivariable adjusted logistic and Poisson regression were performed to estimate the association between type of morcellation and surgical outcomes.
Conclusion
Cases performed with power morcellation were associated with fewer complications compared to minilaparotomy. There were no significant differences found among the three morcellation techniques with regard to operating time, length of hospital stay or time required for morcellation.
*p-values from chi-square tests for categorical variables and ANOVA and Kruskal Wallis tests for continuous variables.