Advantages and Disadvantages of Hysteroscopic Morcellation for Removal of Fibroids

Though resection is still the most popular method of removing fibroids, the use of hysteroscopic morcellation has been on the rise since the first hysteroscopic morcellator became available in the United States in 2005.
 
Advantages of Morcellation

Morcellators use a blade and suction tube to simultaneously cut and remove tissue, which improves visibility and reduces the risk of perforations and gas embolus that are more likely with multiple equipment insertions.¹  And because no energy is used in the uterine cavity, there is no risk of thermal injury.

Shorter operating time and ease of use are also among the principle advantages of the intra-uterine morcellator. ^2,3  At an industry-sponsored breakfast at the 41st Global Congress of the American Association of Gynecologic Laparoscopists, AAGL’s past president Richard Gimpelson, MD, said, “If you can use an electric toothbrush, you can use [a] morcellator, that’s about how easy it is.”

Disadvantages of Morcellation

Morcellators cannot cauterize blood vessels and have limited utility in cases of Type II myomas.

For physicians wanting to use a hysteroscopic morcellator to perform in-office procedures, cost of the device and insurance reimbursement can be issues. Although the small size of the device makes it ideal for office procedures, the current system offers the same reimbursement rate for in-office and hospital or surgical-center procedures, which could make it cost-prohibitive for private practices.

Available Hysteroscopic Morcellation Systems

Currently, two morcellation systems are available in the United States: the TRUCLEAR™ Hysteroscopic Morcellator and the MyoSure® Tissue Removal System.

TRUCLEAR™ was the first to market in 2005, and the company released TRUCLEAR™ 5.0 in 2011. With an outer diameter 5 mm and a 2.9 mm morcellator, the TRUCLEAR™ 5.0 is presently the smallest morcellator on the market.

MyoSure® was first approved in 2009. Its system uses a 2mm morcellator and has an outer dimension of 6.25 mm.

References:

1. Munro MG. Complications of hysteroscopic and uterine resectoscopic surgery. Obstet Gynecol Clin N Am.2010;37(3):399–425.
2. van Dongen H, Emanuel MH, Wolterbeek R, et al. Hysteroscopic morcellator for removal of intrauterine polyps and myomas: a randomized controlled pilot study among residents in training. J Minim Invasive Gynecol 2008; 15:466.
3. Emanuel MH, Wamsteker K. The Intra Uterine Morcellator: a new hysteroscopic operating technique to remove intrauterine polyps and myomas. J Minim Invasive Gynecol 2005; 12:62.