Tissue extraction at minimally invasive surgery (RANZCOG)

Question 1

Risks of tissue morcellation?

Answer 1

patient injury
dissemination
poor pathological specimen for review and analysis

Question 2

At what AGES level could morcellation devices be used?

Answer 2

AGES-RANZCOG level 5 and above

Question 3

Precautions prior to morcellation (6)?

Answer 3

1. no suspicion of malignancy on preoperative assessment
2. maintain tip of instrument in view at all times
3. maintain control of specimen at all times
4. feed specimen into morcellator in controlled manner
5. minimise spillage of fragments
6. post-morcellation retrieval of all fragments

Question 4

What routine investigations (to rule out malignancy) should have been performed prior to performing morcellation?

Answer 4

Pap smear
ultrasound
tumor markers
endometrial sampling

Question 5

What is the incidence of leiomyosarcoma?

Answer 5

0.02-0.3%