Impact of Morcellation Method and Site on Laparoscopic Hysterectomy Outcomes in Obese Patients

Objective: This research was conducted to investigate the effect of morcellation method and site on perioperative outcomes in patients with class 3 obesity (body mass indices [BMI] ≥40). Materials and Methods: This was a retrospective cohort study of 159 patients with BMI ≥40 who underwent laparoscopic hysterectomy requiring morcellation from January 2006 to October 2019 at an academic tertiary care center. Morcellation method (manual or electromechanical) and morcellation site (vaginal or abdominal) were analyzed. The primary outcome was 30-day perioperative complications. Results: Thirty-three (21%) patients underwent electromechanical morcellation while 126 (79%) underwent manual morcellation. Of manual morcellation cases, 46 (37%) underwent vaginal morcellation, while 80 (63%) underwent abdominal morcellation. There were no significant differences in age, BMI, parity, prior surgery, or medical comorbidities among the groups. Median specimen weight was larger for patients with abdominal versus vaginal morcellation (808 g versus 455 g; p < 0.01), without a difference in operative time (274 versus 246 minutes; p = 0.06). There were no differences in the incidence of perioperative complications between electromechanical versus manual (36.4% versus 31.8%; p = 0.61) and vaginal versus abdominal (37.0% versus 28.8%; p = 0.34) morcellation. After controlling for potential confounders, there was no difference in complications between electromechanical versus manual (adjusted odds ratio [aOR]: 2.28; 95% confidence interval [CI]: 0.76-6.84) and vaginal versus abdominal (aOR: 1.72; 95% CI: 0.72-4.13) morcellation. Conclusions: In women with BMI ≥40, abdominal morcellation was associated with significantly larger specimen sizes, compared to vaginal morcellation, without an increase in perioperative complications or operative time. Manual and electromechanical morcellation had similar perioperative complication frequencies.