When the FDA warned against laparoscopic power morcellators in the majority of women undergoing laparoscopic hysterectomy for fibroids, there was a shift from power morcellation to contained hand morcellation among minimally invasive surgeons.METHODS:
This retrospective cohort study compares all laparoscopic hysterectomies performed at an academic suburban tertiary care center by power morcellation before the FDA warning to a hand morcellation protocol developed after the FDA warning.RESULTS:
From 2010–2015, 84 cases of laparoscopic hysterectomies requiring morcellation were identified. Of these, 46 involved power morcellation while 35 underwent hand morcellation. The two groups were overall similar in BMI (28.9 vs 29.4, P=.7), prior laparoscopy (28% vs 17%, P=.3) or laparotomy (39% vs 23% P=.12) removal of cervix (56% vs 69%; P=.2), use of robot (8.7% versus 8.6%, P=1) or uterine weight (550 g vs 455 g, P=.98). The hand morcellation group had an average operating room time of 178 min compared to power morcellation, which took 155 min, P<.001. Both groups had rare complications or unscheduled visits. To account for other factors influencing operating room time, a multivariable linear regression model was created. In this model hand morcellation was a significant independent predictor of increase in OR time by 42 min (95% CI = 18–66, P<.001).CONCLUSION:
Hand morcellation significantly increases OR time and further work should focus on improving efficiency of this procedure.