A containment system for morcellation
Dr Brown is Professor, Levine Cancer Institute, Carolinas Health Care System, Charlotte, North Carolina.
The benefits to the patient of minimally invasive surgery are widely known and accepted, and more than 60% of hysterectomies performed in the United States are now done laparoscopically or with the assistance of a robot.1 For decades, the process of removing a large fibroid uterus through a small outlet (port sites or the vagina) has been accomplished through morcellation, in which the uterus is removed in smaller segments.2
Morcellation has been performed either by hand with a scalpel or scissors or using a device with a rotating blade that removes cylinders of specimen through the port site, vagina, or abdominal incision (power morcellation).
Recently, the low but present risk of dissemination of undetected malignancy has limited use of power morcellation in patients undergoing hysterectomy. Consideration of this risk prompted the US Food and Drug Administration (FDA) to issue updated guidelines on use of the power morcellator in 2015, which cautioned against using the device in certain women with uterine fibroids and mandated informed patient consent.3 The recommendation was made by the AAGL, Society of Gynecologic Oncology, and other organizations to develop containment systems so that morcellation might safely be performed, allowing minimally invasive surgery without the risk of dissemination during fragmented removal through small incisions.4-7
Against this background, the PneumoLiner (Advanced Surgical Concepts Ltd, Wicklow, Ireland) was developed and FDA-approved as the first device to allow total containment of tissue, cells, and fluid during a laparoscopic power morcellation procedure (Class II device).8