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Hysteroscopic electromechanical power morcellation


 

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One of the hottest and most controversial topics in gynecologic surgery, at present, is laparoscopic electromechanical power morcellation.

In April of this year, the Food and Drug Administration sent out a news release regarding the potential risk of spread of sarcomatous tissue at the time of this procedure. In that release, the agency "discouraged" use of laparoscopic electromechanical power morcellation. Responses came from many societies, including the American College of Obstetricians and Gynecologists and the AAGL, which indicated that laparoscopic electromechanical power morcellation could be used if proper care was taken.

Dr. Charles E. Miller

I am personally proud that the Master Class in Gynecologic Surgery has been very proactive and diligent in its discussion of laparoscopic electromechanical power morcellation. This is the third in our series regarding this topic.

In our first segment, I discussed the issue of electromechanical power morcellation relative to the inadvertent spread of sarcomatous tissue. In our second in the series, Dr. Ceana Nezhat, Dr. Bernard Taylor, and Dr. Tony Shibley discussed ways to minimize this risk – including morcellation in a bag. Videos of their individual techniques of electromechanical power morcellation, as well as that of Dr. Douglas Brown, can be viewed on SurgeryU. In addition, my partner, Dr. Aarathi Cholkeri-Singh, and I have a video on SurgeryU illustrating our technique of morcellation in a bag.

This current Master Class in Gynecologic Surgery is now devoted to hysteroscopic electromechanical power morcellation. In my discussions with physicians throughout the country relative to this technique, it has become evident that some institutions have not only banned the use of electromechanical power morcellation at time of laparoscopy, but have also stopped usage of hysteroscopic electromechanical power morcellation. While neither the FDA nor the lay press has ever questioned the use of hysteroscopic morcellators, I believe it is imperative that this topic be reviewed. I am sure that it will be obvious that hysteroscopic electromechanical power morcellation has thus far proved to be a safe and effective treatment option for various pathologic entities, including submucosal uterine fibroids.

To review hysteroscopic electromechanical power morcellation, I have invited Dr. Joseph S. Sanfilippo, professor of obstetrics, gynecology, and reproductive sciences at the University of Pittsburgh and director of the division of reproductive endocrinology and infertility at Magee-Womens Hospital in Pittsburgh.

Dr. Sanfilippo is a lecturer and educator. He has written an extensive number of peer-reviewed articles, and has been a contributor to several textbooks. In addition, Dr. Sanfilippo has been and remains a very active member of the AAGL.

It is a pleasure and honor to welcome Dr. Sanfilippo to this edition of the Master Class in Gynecologic Surgery, the third installment on morcellation.

Dr. Miller is clinical associate professor at the University of Illinois at Chicago, immediate past president of the International Society for Gynecologic Endoscopy, and a past president of the AAGL. He is a reproductive endocrinologist and minimally invasive gynecologic surgeon in private practice in Naperville, Ill., and Schaumburg, Ill.; the director of minimally invasive gynecologic surgery at Advocate Lutheran General Hospital, Park Ridge, Ill. and the medical editor of this column, Master Class. Dr. Miller disclosed that he is a consultant to Hologic and is on the speakers bureau for Smith & Nephew. Videos for this and past Master Class in Gynecology Surgery articles can be viewed on SurgeryU.

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