title: Transvaginal morcellation.
abstract: OBJECTIVE
  Transvaginal uterine morcellation has been described in the literature for more than a century. Despite an extensive body of literature documenting its safety and feasibility, concerns about morcellating occult malignant entities have raised questions regarding this technique. In this study, we looked at a single teaching institution's experience with transvaginal morcellation for leiomyomatous uteri. In addition, we reviewed the published literature for outcomes associated with transvaginal morcellation techniques.
  
  
  METHODS
  This study was a retrospective case series. Charts of women who underwent total laparoscopic hysterectomy, robot-assisted laparoscopic hysterectomy, and laparoscopic-assisted vaginal hysterectomy for leiomyoma from July 1, 2011, through December 31, 2013, were reviewed. Cases were included if transvaginal morcellation was performed. Morcellation was performed by bringing the uterus into the vagina and by performing a wedge resection technique to reduce the volume of the specimen. Baseline demographics and intra- and postoperative outcomes were abstracted from the charts. A PubMed search from January 1, 1970 to October 31, 2014 was performed to review the literature regarding transvaginal morcellation.
  
  
  RESULTS
  Sixty-four women who underwent laparoscopy for leiomyomatous uteri with transvaginal morcellation were identified from July 1, 2011 through December 31, 2013. Mean operative time was 210 minutes (SD 75.5; range, 93-420). The mean blood loss was 153 mL (SD 165; range, 25-1000). The mean uterine size was 608 g (SD 367; range, 106-1834). There were no surgical complications directly attributed to morcellation. The literature search yielded 22 articles describing outcomes after transvaginal morcellation, with a total of 1953 morcellated specimens.
  
  
  CONCLUSIONS
  Transvaginal uterine morcellation appears to be a safe alternative to laparotomy for the removal of large uterine specimens in select patients.
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Clark Donat
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Clark
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Tower
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Gulden
authors.initials: G
authors.lastname: Menderes
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Vinita
authors.initials: V
authors.lastname: Parkash
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Dan-Arin
authors.initials: DA
authors.lastname: Silasi
authors.affiliation: Department of Obstetrics and Gynecology, Bridgeport Hospital, Yale New Haven Health System, Connecticut.
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D000069577:Morcellation / Q000379:methods*; D061646:Operative Time; D009929:Organ Size; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000601:surgery
keywords: Fibroid; Laparoscopic abdominal vaginal hysterectomy; Leiomyoma; Transvaginal morcellation