A New Laparoscopic Morcellator Using an Actuated Wire Mesh and Bag

Abstract

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.

Laparoscopic excision of large omental cyst at department of pediatric surgery in Sanglah general hospital, Bali, Indonesia

“…2 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. 4 The morcellators are tiny devices with rotating blades that break large tissue masses into small fragments. 5 Tissue morcellation during gynecologic surgery has been widely practiced to facilitate removal of large uteri or uterine myomas through less invasive incisions than those used in a traditional laparotomy.…”

A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

“…74 Another recent report describes an enclosed, motor-actuated mesh that applies inward-directed cutting force to tissue that has been loaded into mesh within a protective bag. 75 This approach could be applied to a larger range in tissue size and density as compared with current power morcellators, while decreasing the risks of seeding and injury to other organs and structures. As contained power morcellation techniques gain approval for in vivo use, they likely will become the predominant approach with the advantages of decreased operative time while avoiding dissemination of endometriosis or malignancy and decreasing intraoperative injury as compared with current open morcellation techniques.…”

Should We Abandon All Conservative Treatments for Uterine Fibroids? the Problem with Leiomyosarcomas

“…Einarsson et al have reported on the technique of contained electromechanical or ‘in bag’ morcellation which may help avoid tissue dissemination and visceral injury, however further studies are needed [62]. New devices specifically aimed at contained mechanical morcellation are in development [66].…”