Instruments and Techniques
Laparoscopic Morcellator-Related Complications

https://doi.org/10.1016/j.jmig.2013.12.003Get rights and content

Abstract

Morcellation at laparoscopy is a commonly used minimally invasive method to extract bulky tissue from the abdomen without extending abdominal incisions. Despite widespread use of morcellation, complications still remain underreported and poorly understood. We performed a systematic review of surgical centers in the United States to identify, collate and update the morcellator-related injuries and near misses associated with powered tissue removal. We searched articles on morcellator-related injuries published from 1993 through June 2013. In addition, all cases reported to MedSun and the FDA device database (MAUDE) were evaluated for inclusion. We used the search terms “morcellation,” “morcellator,” “parasitic,” and “retained” and model name keywords “Morcellex,” “MOREsolution,” “PlasmaSORD,” “Powerplus,” “Rotocut,” “SAWALHE,” “Steiner,” and “X-Tract.” During the past 15 years, 55 complications were identified. Injuries involved the small and large bowels (n = 31), vascular system (n = 27), kidney (n = 3), ureter (n = 3), bladder (n = 1), and diaphragm (n = 1). Of these injuries, 11 involved more than 1 organ. Complications were identified intraoperatively in most patients (n = 37 [66%]); however, the remainder were not identified until up to 10 days postoperatively. Surgeon inexperience was a contributing factor in most cases in which a cause was ascribed. Six deaths were attributed to morcellator-related complications. Nearly all major complications were identified from the FDA device database and not from the published literature. The laparoscopic morcellator has substantially expanded our ability to complete procedures using minimally invasive techniques. Associated with this opportunity have been increasing reports of major and minor intraoperative complications. These complications are largely unreported, likely because of publication bias associated with catastrophic events. Surgeon experience likely confers some protection against these injuries. Understanding and implementing safe practices associated with the use of the laparoscopic morcellator will reduce these iatrogenic injuries.

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Materials and Methods

The FDA operates the Medical Device Reporting (MDR) and Manufacturer and User Facility Device Experience (MAUDE) databases. The MDR database enables one to search for information about medical devices that may have malfunctioned or caused a death or serious injury during 1992 through 1996. Searchable data in the MAUDE system provide reports of adverse events involving medical devices. The data consist of all voluntary reports since June 1993, user facility reports since 1991, distributor

Results

Table 1 gives a summary of the morcellators currently available in the United States for each device. The diameter of the morcellator outer sheath ranges from 12 to 20 mm, with speeds up to 1200 revolutions per minute. One morcellator is completely disposable, and another is completely reusable. Most have some reusable and disposable parts. Most use a foot pedal for activation. One device has no moving parts and uses bipolar technology for morcellation.

As morcellators have become more

Discussion

The laparoscopic approach to gynecologic, urologic, and general surgery has expanded during the past few decades, in large part because of improved instrumentation, techniques, and experience. The laparoscopic morcellator is arguably one of the most important and powerful tools in the armamentarium of a minimally invasive surgeon. It facilitates removal of large specimens that previously required laparotomy, enabling a minimally invasive approach and providing the patient a shorter hospital

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The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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