Laparoscopic morcellation is a technique used in gynecological surgeries such as hysterectomy and myomectomy to remove uteri and uterine fibroids (leiomyomas) through a small abdominal incision. Current morcellators use blades or bipolar energy to cut tissue into small pieces that are then removed through laparoscopic ports in a piecewise manner. These existing approaches have several limitations; (1) they are time consuming as the tissue must be manually moved over the devices during the cutting step and removal is piecewise, (2) they can lead to accidental damage to surrounding healthy tissue inside the body and (3) they do not provide safe containment of tissue during the morcellation process which can lead to seeding (spreading and regrowth) of benign or potentially cancerous tissue. This paper describes a laparoscopic morcellator that overcomes these limitations through a new design that is based on an enclosed, motor-actuated mesh that applies only an inward-directed cutting force to the tissue after it has been loaded into the protective mesh and bag. The deterministic design approach that led to this concept is presented along with the detailed electromechanical design. The prototype is tested on soft vegetables and an animal model to demonstrate successful morcellation and how the device would be compatible with current clinical practice. Results show that the time required to morcellate with the new device for a set of tests on animal tissue is relatively uniform across samples with widely varying parameters. Including tissue manipulation and extraction time, the new device is shown to have an improvement in terms of speed over current morcellators. The mean time for cutting animal tissue ranging from 100 g to 360 g was 30 s with small variations due to initial conditions. The time for cutting is expected to remain approximately constant as tissue size increases. There is also minimal risk of the protective bag ripping due to the inward-cutting action of the mesh, thereby potentially significantly reducing the risk of seeding during clinical procedures; thus, further increasing patient safety. Finally, this design may be applicable to other procedures involving removal of tissue in nongynecologic surgeries, such as full or partial kidney or spleen removal.

References

References
1.
Keshavarz
,
H.
,
Hillis
,
S. D.
,
Kieke
,
B. A.
, and
Marchbanks
,
P. A.
,
2002
, “
Hysterectomy Surveillance: United States, 1994–1999
,” Centers for Disease Control and Prevention, Atlanta, GA, MMWR Surveillance Summaries, Report No. SS05.
2.
Milad
,
M. P.
, and
Sokol
,
E.
,
2003
, “
Laparoscopic Morcellator-Related Injuries
,”
J. Am. Assoc. Gyn. Laparoscopists
,
10
(
3
), pp.
383
385
.10.1016/S1074-3804(05)60267-8
3.
Gargiulo
,
A. R.
,
2012
, private communication.
4.
Park
,
J. Y.
,
Park
,
S. K.
,
Kim
,
D. Y.
,
Kim
,
J. H.
,
Kim
,
Y. M.
,
Kim
,
Y. T.
, and
Nam
,
J. H.
,
2011
, “
The Impact of Tumor Morcellation During Surgery on the Prognosis of Patients With Apparently Early Uterine Leiomyosarcoma
,”
Gyn. Oncol.
,
122
(
2
), pp.
255
259
.10.1016/j.ygyno.2011.04.021
5.
Susman
,
E
.,
2011
, “
Big Concerns About Inadvertent Use of Morcellation in Previously Undiagnosed Uterine Leiomyosarcoma
,”
Oncol. Times
,
33
(
10
), pp.
66
67
.10.1097/01.COT.0000398794.55192.9d
6.
Sinha
,
R.
,
Sundaram
,
M.
,
Mahajan
,
C.
, and
Sambhus
,
A.
,
2007
, “
Multiple Leiomyomas after Laparoscopic Hysterectomy: Report of Two Cases
,”
J. Minimally Invasive Gyn.
,
14
(
1
), pp.
123
127
.10.1016/j.jmig.2006.08.002
7.
Wattiez
,
A.
,
Soriano
,
D.
,
Fiaccavento
,
A.
,
Canis
,
M.
,
Botchorishvili
,
R.
,
Pouly
,
J.
,
Mage
,
G.
, and
Bruhat
,
M. A.
,
2002
, “
Total Laparoscopic Hysterectomy for Very Enlarged Uteri
,”
J. Am. Soc. Gyn. Laparoscopists
,
9
(
2
), pp.
125
130
.10.1016/S1074-3804(05)60119-3
8.
Ghomi
,
A.
,
Littmann
,
P.
,
Prasad
,
A.
, and
Einarsson
,
J. I.
,
2007
, “
Assessing the Learning Curve for Laparoscopic Supracervical Hysterectomy
,”
J. Soc. Laparoendoscopic Surgeons
,
11
(
2
), pp.
190
194
.
9.
Sinha
,
R.
,
Sundaram
,
M.
,
Lakhotia
,
S.
,
Mahajan
,
C.
,
Manaktala
,
G.
, and
Shah
,
P.
,
2009
, “
Total Laparoscopic Hysterectomy for Large Uterus
,”
J. Gyn. Endoscopy Surgery
,
1
(
1
), pp.
34
39
.10.4103/0974-1216.51908
10.
Rosenblatt
,
P. L.
,
2012
, private communication.
11.
Wang
,
K.
,
2012
, private communication.
12.
Sinha
,
R.
,
Hegde
,
A.
,
Mahajan
,
C.
,
Dubey
,
N.
, and
Sundaram
,
M.
,
2008
, “
Laparoscopic Myomectomy: Do Size, Number, and Location of the Myomas Form Limiting Factors for Laparoscopic Myomectomy?
J. Min. Invasive Gyn.
,
15
(
3
), pp.
292
300
.10.1016/j.jmig.2008.01.009
13.
Slocum
,
A. H.
, and
Graham
,
M. M.
,
2005
, “
Product Development by Deterministic Design
,”
1st International CDIO Conference
and Collaborator's Meeting,
Ontario, Canada
, June 6–9.
14.
Rivard
,
C.
,
Salhadar
,
A.
, and
Kenton
,
K.
,
2012
, “
New Challenges in Detecting, Grading, and Staging Endometrial Cancer After Uterine Morcellation
,”
J. Min. Invasive Gyn.
,
19
(
3
), pp.
313
316
.10.1016/j.jmig.2011.12.019
15.
Zullo
,
F.
,
Falbo
,
A.
,
Iuliano
,
A.
,
Oppedisano
,
R.
,
Sacchinelli
,
A.
,
Annunziata
,
G.
,
Venturella
,
R.
,
Materazzo
,
C.
,
Tolino
,
A.
, and
Palomba
,
S.
,
2010
, “
Randomized Controlled Study Comparing the Gynecare Morcellex and Rotocut G1 Tissue Morcellators
,”
J. Min. Invasive Gyn.
,
17
(
2
), pp.
192
199
.10.1016/j.jmig.2009.11.009
16.
The Anchor Tissue Retrieval System
,” 2012, Anchor Surgical, Addison, IL, www.anchorsurgical.com/AnchorSurgical_TRS_2011.pdf
17.
Retrieval Sac
,” 2012, Anchor Surgical, Addison, IL, www.anchorsurgical.com/tissue_retrieval.html
18.
Brucker
,
S.
,
Solomayer
,
E.
,
Sawalhe
,
S.
,
Wattiez
,
A.
, and
Wallwiener
,
D.
,
2007
, “
A Newly Developed Morcellator Creates a New Dimension in Minimally Invasive Surgery
,”
J. Min. Invasive Gyn.
,
14
(
2
), pp.
233
239
.10.1016/j.jmig.2006.10.004
19.
Rassweiler
,
J.
,
Stock
,
C.
,
Frede
,
T.
,
Seemann
,
O.
, and
Alken
,
P.
,
1998
, “
Organ Retrieval Systems for Endoscopic Nephrectomy: A Comparative Study
,”
J. Endourology
,
12
(
4
), pp.
325
333
.10.1089/end.1998.12.325
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