1 / 26

Morcellation

Morcellation. Gustavo Plasencia MD, FACS, FASCRS Clinical Professor of Surgery Florida International University Stelio Rekkas MD. Disclosures. Ethicon Endosurgery Consultant. Incisions. Morcellation.

kylee-patterson
Download Presentation

Morcellation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Morcellation Gustavo Plasencia MD, FACS, FASCRS Clinical Professor of Surgery Florida International University Stelio Rekkas MD

  2. Disclosures • Ethicon Endosurgery Consultant

  3. Incisions

  4. Morcellation

  5. You are driving down the road in your car on a wild, stormy night, when you pass by a bus stop and you see three people waiting for the bus: • An old lady who looks as if she is about to die. • 2. An old friend who once saved your life. • 3. The perfect partner you have been dreaming about. • Which one would you choose to offer a ride to, knowing that there could only be one passenger in your car?

  6. "I would give the car keys to my old friend and let him take the lady to the hospital. I would stay behind and wait for the bus with the partner of my dreams. Never forget to "Think Outside of the Box”

  7. To Morcellate or Not to Morcellate, that is the question.Why aren’t we doing this more?

  8. Pathology • Relatively unchanged techniques • Is there a better way to evaluate our specimens? • Progressive Pathologist • Preop Radiological Staging • Preop Histopathological staging

  9. Introduction: Tissue Morcellation • Morcellation—the grinding and removal of tissue • Etymology • Medieval Latin morsellum  “to bite”

  10. Introduction: Tissue Morcellation • Common used for spleen, uterus, kidney, in benign diseases • Piecemeal extraction of tissues • Avoid extraction incisions. Use only trocar sites; may be slightly enlarged, dilated

  11. Principles for Morcellation • Only performed for benign disease • Requires impermeable entrapment bag • Check bag for perforation • Maintenance of pneumoperitoneum • Avoid overflow in the bag by frequent suction of fluid and tissues

  12. Principles for Morcellation • Change gloves after tissue extraction • Any manipulation should be done with atraumatic instruments • Perform under laparoscopic visualization

  13. Advantages • Less post-operative pain • Improved cosmesis • Potential advantages • Reduced risk of incisional hernias • Decreased risk of wound infection • Quicker return to activities

  14. Disadvantages • Injury to adjacent tissues when morcellating • Extra cost if using morcellating device • Longer OR times • Not recommended for malignant disease today

  15. Indications • Benign Disease • Diverticulitis • Inflammatory Bowel Disease • Ischemic Colitis • Rectal Prolapse • Colonic Inertia • Volvulus • AVM

  16. Indications • Malignancy • When staging is not imperative • Palliative resection

  17. Malignancy? • Cannot obtain adequate staging of cancer, due to destruction of primary as well as lymph nodes

  18. Electric Morcellators Storz Morcellator Cook morcellator Coherent morcellator Ethicon morcellator

  19. Electric Morcellators • Organ isolated in bag • Prefabricated or fashioned • Used blades to grind tissue, suction to remove • Dangerous because bag easily punctured • Where are the colon morcellators?

  20. How we do it • Tissues morcellated without any equipment. • Or as an alternative a Morcellator • Lapsac used

  21. Machine Morcellation Video

  22. Conclusions • Indicated for benign or palliative colon surgery • New forms of tissue analysis and staging evaluation are needed preoperatively • Preoperative radiological staging will improve • Histopathological analysis should also be improved upon • We need to always be thinking of the future and how to better serve our patients • Possible and Safe

  23. To Morcellate or Not to Morcellate, that is the question.TO MORCELATE

  24. The End

More Related