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Morcellation. Gustavo Plasencia MD, FACS, FASCRS Clinical Professor of Surgery Florida International University Stelio Rekkas MD. Disclosures. Ethicon Endosurgery Consultant. Incisions. Morcellation.

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morcellation

Morcellation

Gustavo Plasencia MD, FACS, FASCRS

Clinical Professor of Surgery

Florida International University

Stelio Rekkas MD

disclosures
Disclosures
  • Ethicon Endosurgery Consultant
slide6

You are driving down the road in your car on a wild, stormy night, when you pass by a bus stop and you see three people waiting for the bus:

  • An old lady who looks as if she is about to die.
  • 2. An old friend who once saved your life.
  • 3. The perfect partner you have been dreaming about.
  • Which one would you choose to offer a ride to, knowing that there could only be one passenger in your car?
slide7

"I would give the car keys to my old friend

and let him take the lady to the hospital.

I would stay behind and wait for the bus

with the partner of my dreams.

Never forget to "Think Outside of the Box”

pathology
Pathology
  • Relatively unchanged techniques
  • Is there a better way to evaluate our specimens?
  • Progressive Pathologist
  • Preop Radiological Staging
  • Preop Histopathological staging
introduction tissue morcellation
Introduction: Tissue Morcellation
  • Morcellation—the grinding and removal of tissue
  • Etymology
    • Medieval Latin morsellum  “to bite”
introduction tissue morcellation1
Introduction: Tissue Morcellation
  • Common used for spleen, uterus, kidney, in benign diseases
  • Piecemeal extraction of tissues
  • Avoid extraction incisions. Use only trocar sites; may be slightly enlarged, dilated
principles for morcellation
Principles for Morcellation
  • Only performed for benign disease
  • Requires impermeable entrapment bag
  • Check bag for perforation
  • Maintenance of pneumoperitoneum
  • Avoid overflow in the bag by frequent suction of fluid and tissues
principles for morcellation1
Principles for Morcellation
  • Change gloves after tissue extraction
  • Any manipulation should be done with atraumatic instruments
  • Perform under laparoscopic visualization
advantages
Advantages
  • Less post-operative pain
  • Improved cosmesis
  • Potential advantages
    • Reduced risk of incisional hernias
    • Decreased risk of wound infection
    • Quicker return to activities
disadvantages
Disadvantages
  • Injury to adjacent tissues

when morcellating

  • Extra cost if using morcellating device
  • Longer OR times
  • Not recommended for malignant disease today
indications
Indications
  • Benign Disease
    • Diverticulitis
    • Inflammatory Bowel Disease
    • Ischemic Colitis
    • Rectal Prolapse
    • Colonic Inertia
    • Volvulus
    • AVM
indications1
Indications
  • Malignancy
    • When staging is not imperative
      • Palliative resection
malignancy
Malignancy?
  • Cannot obtain adequate staging of cancer, due to destruction of primary as well as lymph nodes
electric morcellators
Electric Morcellators

Storz Morcellator

Cook morcellator

Coherent morcellator

Ethicon morcellator

electric morcellators1
Electric Morcellators
  • Organ isolated in bag
    • Prefabricated or fashioned
  • Used blades to grind tissue, suction to remove
  • Dangerous because bag easily punctured
  • Where are the colon morcellators?
how we do it
How we do it
  • Tissues morcellated without any equipment.
  • Or as an alternative a Morcellator
  • Lapsac used
conclusions
Conclusions
  • Indicated for benign or palliative colon surgery
  • New forms of tissue analysis and staging evaluation are needed preoperatively
  • Preoperative radiological staging will improve
  • Histopathological analysis should also be improved upon
  • We need to always be thinking of the future and how to better serve our patients
  • Possible and Safe