Current Methods of Tissue Extraction in Minimally Invasive Surgical Treatment of Uterine Fibroids

Background and Objectives: Since the 2014 Food and Drug Administration communication regarding the use of power morcellation, gynecologists have adopted alterna-tive tissue extraction strategies. The objective of this study is to investigate the current techniques used by gyneco-logic surgeons for tissue extraction following minimally invasive hysterectomy or myomectomy for fibroids.Methods: An online survey was distributed to all AAGL members and responses were collected between March 26, 2019 and April 17, 2019.Results: Four hundred thirty-six respondents completed the survey. For hysterectomy, the most common methods of tissue extraction were manual morcellation through the colpotomy (72.4%) or minilaparotomy (66.9%). Nearly one-third (31.7%) endorsed using power morcellation. For myo-mectomy, manual morcellation via minilaparotomy (71.9%) was the most common approach, followed by power morcellation (35.7%). Use of containment bags was com-mon. Minilaparotomy incisions were typically three cm and most often at the umbilicus.Geographic differences were detected, particularly with power morcellation. During hysterectomy, 18.4% of US-based surgeons reported its use, compared to 56.9% of nonUS-based surgeons. During myomectomy, 20.5% of US-based surgeons reported its use compared to 67.5% of their international counterparts. Age, years in practice, fellowship training, and practice location were all significantly associated with power morcellator use.Conclusion: A large majority of practitioners are perform-ing manual morcellation through the colpotomy or minila-parotomy. Use of containment bags is common with all routes of tissue removal. Power morcellation use is less common in the United States than in other countries.