Morcellation

Morcellation

This is the process whereby larger tissue is broken down into smaller pieces, facilitating their removal through smaller inci sions in the abdomen. In gynaecology , this is usually o ff ered in the context of a laparoscopic myomectomy to remove fibroids or a laparoscopic subtotal hysterectomy to remove the bod the uterus. This procedure is undertaken with an instrument called a morcellator. The risks associated with morcellation include parasitic spread of tissue where the cut tissue deposits of previously undiagnosed malignancies (noting that this is also considered a risk during an open myomectomy if the fibroid - capsule is breached), as well as missed malignancies owing to lost anatomy . Retrieval bags have been proposed to prevent dissemination of the tissue but the evidence regarding their use is currently awaited. In view of this, careful case selection is important. The risk of an uterine sarcoma increases as age increases, in the perimenopausal and postmenopausal stages of - BRCA mutations and Lynch syndrome, life, in the presence of and in the context of rapidly growing fibroids non-responsive to oestrogen deprivation.

Figure 87.22 Magnetic resonance imaging of uterine /f_i broids.