Safe vaginal uterine morcellation following total laparoscopic hysterectomy.

Günthert, Andreas R; Christmann, Corina; Kostov, Plamen; Mueller, Michael (2015). Safe vaginal uterine morcellation following total laparoscopic hysterectomy. American journal of obstetrics and gynecology, 212(4), 546.e1-546.e4. Elsevier 10.1016/j.ajog.2014.11.020

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The minimally invasive approach for hysterectomy with proven benefits and lower morbidity has become the gold standard, even in women with large uterine masses. Most women with a malignant condition present with abnormal vaginal bleeding and/or suspicious imaging such that few are diagnosed by final histopathology after surgery. However, if a malignancy is not diagnosed preoperatively, intraabdominal morcellation for uterus extraction has an increased risk for potential tumor spread and peritoneal metastases, especially in cases of unexpected leiomyosarcoma. We describe a simple method to wrap the uterus in a contained environment with a plastic bag through the posterior vaginal fornix prior to conventional coring morcellation for vaginal extraction in total laparoscopic hysterectomy. We further describe our experience with a risk stratification and treatment algorithm to implement this procedure in daily routine. A video and an illustrating sketch demonstrate the simplicity and safety of the procedure.

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