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Simplified Laparoscopic Abdominal MorcellationOne of the most difficult steps in performing operative laparoscopy is the removal of large specimens without resorting to laparotomy or culdotomy (opening the abdomen or vagina, respectively). Specimen size has been the most common reason for gynecologists to choose laparotomy over the preferred, minimally-invasive laparoscopy. During the 1980's and early 1990's, many laparoscopic procedures were converted to laparotomies in order to decrease the operative time, but these decisions resulted in a great number of patients undergoing lengthy laparoscopic procedures, only to end up with a laparotomy that, of course, could have been performed in the first place. To overcome these problems, in 1992 our group developed the technique of Simplified Laparoscopic Abdominal Morcellation (SLAM). Large specimens are cut in strips by using a knife with a retractable #11 blade. The cuts are always done in a forward motion, away from any intra-abdominal structure, while the specimen is held in place by two secure graspers, or laparoscopic tenacula. The multiple resulting strips are then easily extracted after removal of the suprapubic cannula. Since the introduction of the SLAM Technique, more patients are eligible for laparoscopy, and fewer have to suffer the long recovery, scarring, and other unfortunate side effects that result from laparotomy. An example of our SLAM technique can be viewed online in Part 2 of a video demonstrating our advanced technique of laparoscopic multiple myomectomies as a conservative alternative to hysterectomy. Please click here.
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