Background: Cutting the cervix, morcellation, and extraction of the uterus and myomata remain major problems in endoscopic surgery. We developed an efficient, safe, reusable, and inexpensive instrument to cut the cervix and morcellate the uterus and myomata: the morcellator knife.
Instrument: The morcellator knife is a classic lancet with an interchangeable blade, transformed into an endoscopic instrument that can be inserted easily through a 10-mm-diameter trocar. The blade has an automatic retraction system and is set in the standby position, ensuring security. Cutting the cervix and uterine or myoma fragmentation are easy. The mass to be cut is held between two grasping forceps for easy cutting with the blade, under permanent visual control. After morcellation, extraction of the masses is performed through a posterior culdotomy.
Experience: We have used this morcellator knife in 54 subtotal hysterectomies and 16 myomectomies. There were no complications during the procedures. Morcellation lasted 3–14 minutes and involved the use of an average of two to three blades.
Conclusion: The morcellator knife is a simple, safe, reusable, and inexpensive instrument with a low maintenance cost.
Benign diseases of the uterus account for a large percentage of gynecologic surgical procedures. The technologic progress of endoscopy has enabled avoidance of laparotomy in many cases, resulting in shorter hospital stays and financial savings.1,2 Hysterectomy and myomectomy are frequent surgical procedures done using endoscopy.3–5 Independent of operative criteria, two technical difficulties are encountered in these procedures that need to be overcome. First, the operating field must be bloodless while the uterine cervix is being cut during supracervical hysterectomy; and second, large masses such as the uterus or leiomyomatas must be morcellated before extraction. Commonly used cutting methods involving monopolar electrodes or laser beams produce large quantities of smoke and carry the risk of distant electric injury. Morcellator systems are expensive, and extraction of masses by morcellator has been known to cause bowel injury.6–10
To minimize those difficulties, a new instrument has been developed that looks like an endoscalpel: the morcellator knife. Our experience with it and its advantages are presented.