Abstract
Objective: To determine the present status of morcellation during a laparoscopic myomectomy via a multicenter questionnaire.
Design: Postal questionnaire survey.
Setting: 180 member hospitals of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE).
Patients: None
Interventions: None.
Main outcome measures: Common clinical practices.
Results: In order to determine the safest procedure, the author submitted a multicenter questionnaire to gynecologic laparoscopists who were certified by the JSGOE. We received 107 completed surveys (60% response rate). Some differences were found between electric morcellation and extraction via an incision in the posterior vaginal fornix. Difficulties were encountered with electrical morcellation in regard to the size and hardness of the leiomyomas; in addition, the cost of the device was a factor. When difficulty is encountered with electrical morcellation, the surgeon should consider conversion to a laparoscopic assisted myomectomy, crushing with an ultrasonic incision apparatus, use of a scalpel, and extraction from the vaginal fornix or abdominal incision. Rare complications associated with either approach were reported, including bladder and bowel injury. Maintaining an adequate field of view and an appropriate position of the morcellator to avoid squeezing it into the abdominal cavity is important.
Conclusions: The result of the questionnaire revealed that methods are available that can reduce complications with a laparoscopic myomectomy; these methods evolve with the surgeon's experience. This paper might aid laparoscopists in the development of appropriate methods for morcellation during a laparoscopic myomectomy; thus, increasing the safety of the procedure.
