ABSTRACT
Laparoscopic morcellation for fibroids and uterus with fibroids began in 1993. Methods and types of morcellators have changed over the years. We evaluate the phases of modification of methods of morcellation. Over time, different devices from Steiner’s, Power morcellator—morcellax, Sawalhe’s, Rotocut, Versator, and other morcellators were used. Poor man’s morcellator posterior colpotomy carried out vaginally in parous women was also an option. In April 2014, the US Food and Drug Administration’s restriction on the use of morcellator for fibroid or large uterus with fibroid brought morcellation almost to a standstill. In May 2015, we began to evaluate the option of visual contained in-bag morcellation at our center. The steps of this procedure are described in detail. The actual risk of a surprise finding of leiomyosarcoma in a case thought to be fibroid is evaluated. Concern over leiomyomatosis after laparoscopic conventional morcellation is also evaluated. Although leiomyosarcoma is extremely rare, no methods are currently available to accurately diagnose it prior to surgery. In our large study of visual contained in-bag morcellation, we find that leiomyomatosis and port-site fibroids are nearly solved. Lastly, there is no strong evidence in the literature to conclude that a fibroid can actually become a leiomyosarcoma. The authors feel that the benefits of minimal access surgery and laparoscopic visual contained in-bag morcellation for fibroids are current options to consider.
