title: Uterine morcellation at the time of hysterectomy: techniques, risks, and recommendations.
abstract: OBJECTIVE
  Uterine leiomyomata or fibroids are the most common pelvic tumor experienced in women. A minimally invasive approach to hysterectomy has proven benefits of cosmesis, lower blood loss, less pain, decreased hospital stay, and faster recovery. The incidence of uterine morcellation, the process of making a uterine specimen smaller for purposes of removal via a minimally invasive approach, has increased for this reason.
  
  
  OBJECTIVE
  We review the history, techniques, and direct and indirect risks described in the literature, recommendations for appropriate use, and how to counsel patients regarding this procedure.
  
  
  METHODS
  A thorough search of PubMed for all current literature was performed. Techniques for morcellation were reviewed. We included studies that addressed the type and incidence of morcellator-associated risks including those addressing the incidence of leiomyosarcoma in patients with presumed uterine fibroids.
  
  
  RESULTS
  We have summarized several techniques to aid the practitioner in performing morcellation procedures and the risks involved. We have summarized all of the current consensus statements regarding the recommendations for use of morcellation and the approach to proper counseling.
  
  
  CONCLUSIONS
  Morcellation is an effective method of specimen removal that can decrease the need for laparotomy in both benign and malignant conditions. Upon analysis of current data and consensus statements, when possible, morcellation should be performed within a contained environment to minimize any potential tumor spread in the event of an undiagnosed malignancy. Patients should be adequately counseled to make an informed decision regarding undergoing a morcellation procedure. Future methods for enclosed specimen extraction will hopefully change the future of morcellation.
authors.affiliation: Fellow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Stine
authors.affiliation: Chair and Robert A. Ross Distinguished Professor, Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.affiliation: Professor and Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D003376:Counseling; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007258:Informed Consent; D018231:Leiomyomatosis / Q000601:surgery; D012307:Risk Factors; D014594:Uterine Neoplasms; D014599:Uterus / Q000601:surgery*