Showing papers on "Morcellator published in 2009"
TL;DR: In patients with stage I LMS, primary surgery involving tumor injury seems to be associated with a worse prognosis than total hysterectomy as a primary intervention.
Abstract: Background: Uterine leiomyosarcoma (LMS) has a poor prognosis even after early-stage diagnosis. Because there are no accurate diagnostic tools for preoperatively distinguishing LMS from uterine leiomyoma, surgeons might opt for partial surgical procedures such as myomectomy or subtotal hysterectomy. We sought to determine whether a surgical procedure that cuts through the tumor influences prognosis. Materials and Methods: Demographic and clinical data of consecutive patients with stage I LMS treated between 1969 and 2005 were reviewed. The study population was divided into group A: patients whose first surgical intervention was total hysterectomy (n = 21); and group B: patients who underwent procedures involving tumor injury, for example, myomectomy, laparoscopic hysterectomy with a morcellator knife, or hysteroscopic myomectomy (n = 16). Survival rates were analyzed and compared. A Cox proportional hazards model was used to assess the association between variables of interest and prognosis. Results: The median age at diagnosis was 50 years (range, 30-74 years). Median follow-up duration was 44 months. The 2 groups did not differ significantly in age at diagnosis, menopausal status, gravidity, parity, postoperative radiotherapy, or time to last follow-up. Kaplan-Meier curves showed significantly better survival rates (P = 0.04) and a significant advantage in recurrence rate (P = 0.03) for group A compared with group B. Survival in group A was 2.8-fold better than that in group B (95% confidence interval, 1.02-7.67). These estimates remained stable after adjustment for age, menopausal status, and radiotherapy. Conclusions: In patients with stage I LMS, primary surgery involving tumor injury seems to be associated with a worse prognosis than total hysterectomy as a primary intervention.
161 citations
TL;DR: Significantly fewer and longer pieces of tissue were removed with the reusable morcellator, and the rate of morcellation was significantly greater in group 2.
9 citations
1 Jan 2009
TL;DR: Early data suggest that this new hysteroscopic morcellator may be a safe and efficient treatment option for the removal of intracavity myomas and polyps.
Abstract: Objective: The objective of this study was to clinically assess the cutting efficiency and safety of a new hysteroscopic morcella tor. Methods: A retrospective review of medical records for 11 premenopausal women who had been treated with the new hys teroscopic morcellator was conducted at 4 hospital or ambulatory surgical center sites. Four physicians performed hysteroscop ic operative procedures to remove intrauterine polyps and type 0 (completely within the uterine cavity), type I (mostly within the cavity), and type II (< 40% within the cavity) submucous myomas. Percent pathology removed, total morcellation time, total fluid used, fluid deficit, and treatment-related adverse events were assessed. Results: In all cases involving polyps and type 0 and type I submucous myomas, 100% of target pathology was removed by the morcellator device. The morcellator removed 50% of target pathology (100% of the intrauterine portion) in the single case involving a type II submucous myoma. For all cases, mean morcel lation time was 3 minutes 3 seconds (range 14 seconds for polyps ≤ 1 cm to 22 minutes 38 seconds for a 4 cm submucous myoma). Fluid deficits for the reported cases ranged from 30 mL to 1,900 mL based on the size of the pathology and associated duration of the procedure. None of the study subjects experienced an adverse event. Conclusions: Early data suggest that this new hysteroscopic morcellator may be a safe and efficient treatment option for the removal of intracavity myomas and polyps.
8 citations
TL;DR: This work reports three cases of parasitic myomas, one case of an endometriotic nodule at a trocar site and one cases of an unintentionally morcellated leiomyosarcoma after Laparoscopic myomectomy and laparoscopic subtotal hysterectomy, and compares them to similar cases published in the literature.
Abstract: The number of laparoscopic myomectomies and hysterectomies has been steadily increasing over the years. Electric morcellators are employed in most cases. Even if the morcellator is carefully applied, remnants of the myoma, uterus or endometrium may remain in the abdomen or at the trocar site. Does this have any consequences for the patient? What happens if an unexpected malignancy is found after morcellation? We report three cases of parasitic myomas, one case of an endometriotic nodule at a trocar site and one case of an unintentionally morcellated leiomyosarcoma after laparoscopic myomectomy and laparoscopic subtotal hysterectomy and compare them to similar cases published in the literature.
3 citations
TL;DR: A 66-year-old woman (para 2) was referred to Kochi Health Sciences Center because of a pelvic tumor and total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed.
Abstract: Uterine leiomyoma is a common benign tumor. This report concerns a rare case of laparoscopic resection of a unilateral, ovarian leiomyoma requiring seven hours of surgery. A 66-year-old woman (para 2) was referred to Kochi Health Sciences Center because of a pelvic tumor. Transvaginal ultrasonographic examination revealed a pelvic tumor suspected of being a uterine leiomyoma in the cul-de-sac. Total laparoscopic hysterectomy and bilateral salpingo-oophorectomy was performed. A morcellator was used to reduce the volume of the leiomyoma. The uterus and right adnexa were removed via the vagina. When the left ovarian leiomyoma was diminished, it was also removed via the vagina.
2 citations
TL;DR: The use of the customized X-TRACT Tissue Morcellator with an electrifiable round cutter allowed the performance of transintestinal hepatectomy and the removal of a solid organ through surgical openings that had been made in the gastrointestinal wall.
Abstract: We tried to determine whether the customization of an X-TRACT Tissue Morcellator could avoid the laceration-induced distension of surgical incisions/openings when transintestinally removing resected liver tissue from the body, when the greatest dimension of the tissue exceeded the dimension of the opening. Pigs were used to examine changes in the caliber and shape of surgical incisions made with a conventional hook knife and insulation-tipped diathermic (IT) knife for electrodissection in endoscopy, and to examine changes in circular incision made with a customized X-TRACT Tissue Morcellator. The ENDO CATCH II device was used to remove tissue. Laceration occurred in the “roundness-lost portion” of the surgical incisions made with the hook knife, thus confirming the greatest dimension of the distended incisions and the occurrence of an irregular laceration. In the circular incision that were made with the customized X-TRACT Tissue Morcellator, by contrast, the removal of resected liver tissue whose greatest dimension was fivefold greater than that of the surgical openings did not increase the caliber of the openings. The shape of the openings remained round, and no laceration was observed. The use of the customized X-TRACT Tissue Morcellator with an electrifiable round cutter allowed the performance of transintestinal hepatectomy and the removal of a solid organ through surgical openings that had been made in the gastrointestinal wall.
2 citations