Tissue morcellator systems: types and how hospitals select one

What is a tissue morcellator?

A tissue morcellator consists of a motor or control unit, a handle with a rotating cutting tube or blade, and a means of drawing tissue into the tube. The specimen is cut into strips or fragments that are withdrawn through the instrument. Without morcellation, large specimens such as uterine fibroids or an enucleated prostate would require a larger incision.

Morcellators are used in laparoscopic hysterectomy and myomectomy, in hysteroscopic removal of intrauterine tissue and in endoscopic prostate enucleation. Because of the tissue-dissemination concerns raised in gynaecology, safe practice now often combines morcellation with a containment bag; see morcellation safety and containment bags.

Laparoscopic morcellator systems

The NOUVAG Morcellation Set is a complete system for laparoscopic hysterectomy and myoma enucleation. A basic set holds the TCM 3000 BL Morcellator control unit, foot pedal, Electronic Motor 21 and spray-tube attachment; a handle set contains the gear unit, handle, cutting tube, optional protection tube or trocar sleeve and obturator. Instruments come in 12 mm and 15 mm diameters.

The BOWA ERGO 300 is a reusable electromechanical morcellator for laparoscopic hysterectomy and myomectomy with working diameters of 12 and 15 mm. Cutting speed is adjustable from 50 to 1000 rpm via a Vario foot switch, the blade can be deactivated for safe insertion and the micro motor is autoclavable. Read more about gynaecologic laparoscopic morcellators and the ERGO 300.

Endourologic morcellators for prostate enucleation

In urology, morcellators are used after endoscopic enucleation of the prostate (EEP, including holmium laser enucleation) to break up the enucleated tissue in the bladder. Richard Wolf's PIRANHA is designed for this and works with SHARK resectoscopes. Its package includes the morcescope, a suction pump set and the Vmax blade, available in disposable and reusable versions, with blade speed of 1500 rpm.

Its suction pump uses a separate container so that tissue remains suitable for histology, which is an important practical feature for urology teams. For more on this application see morcellators for HoLEP.

• Laparoscopic: 12 mm and 15 mm working diameters
• Hysteroscopic: smaller instruments for intrauterine tissue
• Endourologic: used with resectoscopes after enucleation

How to choose a morcellator system

Define the specialty first. A gynaecology department needs 12 or 15 mm laparoscopic instruments and, according to hospital policy, a way to perform contained morcellation. A urology department needs a morcellator compatible with its resectoscope sheaths. Then compare speed control, foot switch design, whether the blade can be deactivated during insertion and which parts are reusable.

Ask about reprocessing, including whether the motor can be autoclaved, blade availability, tubing sets and service. Consider how the system fits your existing towers and power supplies. The article how a morcellator works explains speed settings in more detail.

Safety, regulation and next steps

Check the current guidance from the relevant UAE authority and your professional societies on morcellation in gynaecology, because policy has changed in recent years. Surgeons should decide patient selection; the equipment supplier should supply instructions for use and training. Ask whether the supplier offers containment bags such as BOWA's MetraBag pro, a sterile 3.5-litre bag introduced through a 10 mm trocar.

Beckfinity represents NOUVAG, BOWA and Richard Wolf in the UAE. Contact our specialists to compare morcellator systems or see the MetraBag pro page.