Early Evaluation Of An Electromechanical Morcellator For Laparoscopic Supracervical Hysterectomy

Objective: To evaluate the effectiveness, safety, and cost effectiveness of electromechanical morcellation of the uterus and adnexae to enhance laparoscopic supracervical hysterectomy (LSH). Design: Forty-one consecutive cases of LSH with and without adnexectomy were reviewed. Each case utilized an electromechanical morcellator to accomplish laparoscopic removal of the uterus and adnexae. Setting: Private gynecologic practice in a full service hospital Interventions: LSH Results: The mean uterine weight was 146 g (60-569 g). The mean operating time was 94 minutes (60-225 min.). Actual morcellation time was available in 19 cases by reviewing videotape with an average morcellation time of 11.8 minutes (4-23 min.). Average blood loss was 125 cc (20-600 cc) with one case of late postoperative bleeding requiring operative intervention. The average cost for the procedure was $7,998 ($6,989 $11,581). Thirty-six patients were discharged within 23 hours from the time of admission and all patients were discharged within 48 hours of the time of admission. Conclusions: LSH is a safe and effective method of managing patients that lack cervical pathology or pelvic relaxation. Electromechanical morcellation can enhance the performance of LSH by decreasing operative time. INTRODUCTION All variations of laparoscopic hysterectomy (LH) have been much discussed since first reported by Reich in 1989.1 One particularly controversial form of laparoscopic hysterectomy is subtotal hysterectomy (LSH). LSH was first described by Semm.2 Since that report, several authors have reported their initial experience with various methods for LSH.3-7 One recent report from Belgium has also reviewed 500 cases of LSH..8 recent clinical commentary by Munro discussed the pros and cons of LSH in an editorial entitled "Supracervical Hysterectomy: A Time for Reappraisal".9 We recently published our initial experience with laparoscopic subtotal hysterectomy.10 In this article, we report our initial experiences with an electromechanical morcellator designed for laparoscopy and describe and discuss in detail our other modifications of LSH that we feel simplifies the procedure, and reduces operative time and intraoperative and postoperative complications. MATERIALS AND METHODS From January, 1996 through January, 1997 we reviewed 41 consecutive cases of laparoscopic subtotal hysterectomy performed by our group in Nashville. All operations were performed by the