Intracorporeal electromechanical tissue morcellation: a critical review and recommendations for clinical practice.
Intracorporeal electromechanical tissue morcellation: a critical review and recommendations for clinical practice.
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DOI：
10.1097/aog.0000000000000448
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发表时间：
2014-10
影响因子：
7.2
通讯作者：
Nezhat CH
中科院分区：
文献类型：
--
作者：
Kho KA;Anderson TL;Nezhat CH
机电粉碎器已经受到审查，担心涉及良性和恶性组织医源性传播的并发症。尽管快速旋转的刀片已导致粉碎机相关的血管和内脏损伤，但同样令人担忧的是文献中的多份报告，这些报告表明腹腔内存在组织碎片，如平滑肌瘤、子宫内膜异位症、子宫腺肌病、脾和卵巢组织以及卵巢和子宫的隐匿性癌。经阴道和经小切口行皮质内电粉碎术的替代方法是可行、安全的，并且已被证明具有相当（如果不是上级）的结局，而无需增加剖腹手术的必要性。在密封袋内进行颅内粉碎是另一种将医源性组织接种风险降至最低的选择。患者安全是一个优先事项，具有最大化获益和最小化伤害的平衡目标。当计划进行脑内机电粉碎时，医生应与患者讨论风险和后果。虽然正在收集数据以更清楚地量化和理解这些风险，但在可用时，微创替代非封闭式颅内粉碎术是有利的。外科医生有责任传达实践和器械的风险，并倡导继续改进手术器械和技术。
Electromechanical morcellators have come under scrutiny with concerns about complications involving iatrogenic dissemination of both benign and malignant tissues. Although the rapidly rotating blade has resulted in morcellator-related vascular and visceral injuries, equally concerning are the multiple reports in the literature demonstrating seeding of the abdominal cavity with tissue fragmented such as leiomyomas, endometriosis, adenomyosis, splenic and ovarian tissues, and occult cancers of the ovaries and uterus. Alternatives to intra-corporeal electric morcellation for tissue extirpation through the vagina and through minilaparotomy are feasible, safe, and have been shown to have comparable, if not superior, outcomes without an increased need for laparotomy. Intracorporeal morcellation within a containment bag is another option to minimize the risk of iatrogenic tissue seeding. Patient safety is a priority with balanced goals of maximizing benefits and minimizing harm. When intracorporeal electromechanical morcellation is planned, physicians should discuss the risks and consequences with their patients. Although data are being collected to quantify and understand these risks more clearly, a minimally invasive alternative to unenclosed intracorporeal morcellation is favored when available. It is incumbent on surgeons to communicate the risks of practices and devices and to advocate for continued improvement in surgical instrumentation and techniques.