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Assessing basic "physiology" of the morcellation process and tissue spread: a time-action analysis.

Ewout A Arkenbout1, Lukas van den Haak2, Sara R C Driessen2

  • 1Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.

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Summary

The morcellation process in laparoscopic supracervical hysterectomy (LSH) creates small tissue pieces, increasing scatter risk at the procedure

Keywords:
LaparoscopyMorcellationMorcellatorScatterSpreadTissue

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Area of Science:

  • Minimally Invasive Gynecologic Surgery
  • Surgical Technology and Engineering

Background:

  • Laparoscopic supracervical hysterectomy (LSH) involves power morcellation of uterine tissue.
  • Understanding the morcellation process is crucial for preventing unintended tissue scatter.

Purpose of the Study:

  • To analyze the fundamental steps of the power morcellation process during LSH.
  • To identify factors influencing tissue scatter during morcellation.

Main Methods:

  • Video analysis of LSH procedures using time-action methodology.
  • Categorization of the morcellation process into four distinct stages.
  • Analysis of data stratified by uterine weight (<350g, 350-750g, >750g).

Main Results:

  • The morcellation process consists of tissue manipulation, cutting, depositing, and cleaning stages.
  • A uterine weight cutoff of 350g was identified, beyond which cleaning time was unaffected.
  • Shorter tissue cutting durations (<5 seconds) increased later in the procedure, indicating smaller tissue strip creation.

Conclusions:

  • Tissue scatter risk peaks late in the morcellation process due to the creation of small tissue strips.
  • Current morcellator rotational mechanisms are inefficient, favoring small strip creation.
  • Engineering improvements or alternative mechanisms are needed to minimize tissue scatter during LSH.