title: Power Morcellator Features Affecting Tissue Spill in Gynecologic Laparoscopy: An In-Vitro Study.
abstract: OBJECTIVE
  To assess features of power morcellators (blade diameter, circular vs oscillating cutting, blade rotation speed, experience level) regarding their effect on the amount of tissue spill. In addition, the amount of tissue spill after the initial two-thirds and final one-third of the morcellated specimen was evaluated.
  
  
  METHODS
  In vitro study (Canadian Task Force classification II-2).
  
  
  METHODS
  Laparoscopic skills lab of an academic hospital.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Power morcellation of beef tongue specimens.
  
  
  RESULTS
  Twenty-four trials were performed. Morcellation was performed in 2 phases (phase 1: initial two-thirds of the total tissue; phase 2: last one-third of the tissue). With larger blade diameter a decline was observed in both the weight of the spilled particles (phase 1) and the number of spilled particles (phases 1 and 2 and both combined) (weight phase 1: 6.5 g vs 6.3 g vs 2.2 g for 12.5 mm vs 15 mm vs 20 mm, respectively, p = .04; number particles: phase 1, 10.2 vs 7.2 vs 2.7, p = .01; phase 2, 22.9 vs 19.0 vs 8.9, p = .02; total, 34.7 vs 26.2 vs 11.6, p = .01). Also, spinning of the tissue mass due to torque applied by the rotating blade occurred later when blade size increased, and the size of the spilled particles was larger (weight of morcellated tissue at onset of torque: 136 g vs 198 g vs 222 g, p = .07; size: .6 g vs .9 g vs .8 g, p = .1). In the oscillation mode there was less total spill (6.8 g/100 g vs 21.3 g/100 g, p = .01, for oscillation and circular cutting, respectively).
  
  
  CONCLUSIONS
  The present study demonstrates that less spill is created by power morcellators with an oscillating blade and/or a large diameter (≥20 mm). Furthermore, when using a large-diameter blade the spilled particles are larger, and less morcellation repetitions are needed. By combining these features with currently introduced contained morcellation, the safety of the morcellation process with respect to tissue spill can be further improved.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Lukas
authors.initials: L
authors.lastname: van den Haak
authors.affiliation: Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands.
authors.forename: Ewout A
authors.initials: EA
authors.lastname: Arkenbout
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Evelien M
authors.initials: EM
authors.lastname: Sandberg
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands; Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands. Electronic address: f.w.jansen@lumc.nl.
authors.forename: Frank Willem
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000818:Animals; D002417:Cattle; D004195:Disease Models, Animal; D006801:Humans; D066298:In Vitro Techniques; D010535:Laparoscopy / Q000379:methods; D019060:Minimally Invasive Surgical Procedures; D009929:Organ Size; D014059:Tongue / Q000473:pathology*
keywords: Laparoscopy; Morcellation; Myomas; Power morcellators; Sarcoma; Tissue spill