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Tissue Extraction Techniques for Leiomyomas and Uteri During Minimally Invasive Surgery

Siedhoff, Matthew T. MD, MSCR; Cohen, Sarah L. MD, MPH

doi: 10.1097/AOG.0000000000002334
Contents: Clinical Expert Series
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Expert Discussion

Fragmented tissue extraction (morcellation) of uterine and leiomyoma tissue in gynecologic surgery has been performed for decades, but recent years have seen a vast expansion of techniques to address risks associated with tissue dispersion. Use of power, or electromechanical, morcellation has largely been replaced by manual morcellation with a scalpel. Morcellation can take place through a laparoscopic incision, a minilaparotomy incision, or through a colpotomy. Containment systems are now available for both power and manual morcellation, allowing tissue fragmentation to take place within an enclosed specimen bag. These products require additional training and skill and may add operating time, but have the potential to mitigate risks associated with tissue dissemination.

Morcellation of leiomyoma or uterine tissue during minimally invasive surgery can be accomplished by a variety of techniques, including containment in a specimen bag.

Center for Minimally Invasive Gynecologic Surgery, Cedars-Sinai Medical Center, Los Angeles, California; and the Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.

Corresponding author: Matthew T. Siedhoff, MD, MSCR, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 W 3rd Street, Suite 160, W Los Angeles, CA 90048; email:

Financial Disclosure Dr. Siedhoff has been a paid consultant for Applied Medical (education and clinical development), Olympus (clinical training), and Metronic (education). The remaining author did not report any potential conflicts of interest.

Continuing medical education for this article is available at

The authors thank Dr. Amanda Yunker, who provided images for Figure 3.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.