Post–FDA hearing: Will open power morcellation of uterine tissue remain an option during hysterectomy and myomectomy?
A recent FDA hearing on the use of this technology has cast a cloud over its future. Here, two members of the AAGL Tissue Extraction Task Force discuss the evidence and emphasize the importance of preserving minimally invasive options in women’s health.
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What is your preferred surgical approach?
OBG Management: Do you perform open power morcellation in selected patients?
Dr. Wertheim: Even though I have performed morcellation with a scalpel transvaginally or through a mini-laparotomy incision for many years, I have never used open power morcellation because of the risk of leaving behind benign or malignant tissue fragments. Morcellation with a scalpel is easily learned and can be performed as quickly as power morcellation. Morcellation with a scalpel produces much larger pieces than with power morcellation. This probably markedly decreases the loss of fragments. I cannot make a definitive statement regarding cell loss, however. Until we have improved instrumentation and are better able to make a preoperative diagnosis of sarcoma, I’m going to rule out risk factors identified by the AAGL Task Force, do the appropriate work-up, and continue to morcellate with a scalpel, placing the specimen in a bag, if technically possible.
Dr. Reich: As I mentioned, I am a vaginal scalpel morcellator. I tried power morcellation when it first was developed but was never a fan. The same techniques used for vaginal extraction using a coring maneuver can be used abdominally through the umbilicus or a 1- or 2-cm trocar site.
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