In the past, when hysteroscopy was done to remove a filling defect, small instruments were put through the operating channel of the hysteroscope and the filling defect was either grasped or cut or both. Due to the small size of the hysteroscopic instruments, the surgery was many times difficult, could take 2+ hours to complete, and at times, not be able to even remove the filling defect. This was more common with larger fibroids that were partially embedded in the underlying muscle. In the last 4-5 years, hysteroscopic surgery has experienced a significant breakthrough in technology on how the procedure can be done. This is the use of morcellation technology. Having been used in orthopedic surgery, the hysteroscopic morcellator can simultaneously cut and aspirate tissue; thus, greatly reducing operating time, being able to remove large fibroids that previously were so big and difficult that they had to be removed by an open incision, collect the entire specimen in a trap to be sent to pathology for confirmation, and eliminating pieces of tissue floating in the endometrial cavity sometimes interfering with visualization. The morcellator works on a mechanical design and eliminates the risk of electrical energy in the uterus and thermal damage to surrounding normal endometrial tissue, which other types of hysteroscopic procedures use. Tissue is cut and captured under continuous visualization to ensure efficient and complete removal of the entire filling defect, whether it is a polyp or fibroid. Targeted, visualized treatment reduced the risks of endometrial damage, provides greater control over “blind procedures”, where not all of the filling defect can initially be visualized, and greatly reduces the risk of uterine perforation, since the tip of the morcellator is blunt, as well as the entire shaft of the instrument, except for a small window, where the cutting blade is. It also works with an extremely accurate fluid management system that tracts the amount of fluid in and out, especially during a longer procedure, like a large fibroid, which is very important to avoid patient fluid overload.
VIEW A VIDEO OF THE PROCEDURE AT: https://www.youtube.com/watch?v=hwwxbDzc7iw
