Journal of the European Society for Gynaecological Endoscopy


Mechanical hysteroscopic tissue removal or hysteroscopic morcellator: understanding the past to predict the future. A narrative review

M. Franchini 1, O. Ceci 2, P. Casadio 3, J. Carugno 4, G. Giarrè 5, G. Gubbini 6, U. Catena 7, M. Chiara de Angelis 8, A. Di Spiezio Sardo 9

1 Demetra IVF Center-Villa Cherubini, Florence, Italy
2 Second Unit of Obstetrics and Gynecology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari, Italy
3 Division of Gynaecology and Human Reproduction Physiopathology Unit, DIMEC, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
4 Obstetrics, Gynecology and Reproductive Sciences Department. Minimally Invasive Gynecology Division. University of Miami. Miami, FL USA
5 Private practice at Palagi, Azienda Sanitaria di Firenze, Florence, Italy
6 “Madre Fortunata Toniolo” Hospital, Bologna, Italy
7 Division of Gynecological Oncology, Department for the Protection of Women’s and Children’s Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS L.go A. Gemelli, Rome, Italy
8 Department of Public Health, University of Naples, Italy
9 Department of Public Health, University of Naples, Italy


Hysteroscopic tissue removal system, morcellator, hysteroscopy

Published online: Sep 24 2021


Background: In recent years, the available evidence revealed that mechanical hysteroscopic tissue removal (mHTR) systems represent a safe and effective alternative to conventional operative resectoscopic hysteroscopy to treat a diverse spectrum of intrauterine pathology including endometrial polyps, uterine myomas, removal of placental remnants and to perform targeted endometrial biopsy under direct visualisation. This innovative technology simultaneously cuts and removes the tissue, allowing one to perform the procedure in a safer, faster and more effective way compared to conventional resectoscopic surgery.

Objective: To review currently available scientific evidence concerning the use of mechanical hysteroscopic morcellators and highlight relevant aspects of the technology.

Material and Methods: A narrative review was conducted analysing the available literature regarding hysteroscopic tissue removal systems.

Main outcome measures: Characteristics of available mHTR systems, procedures they are used for, their performance including safety aspects and their comparison.

Results: A total of 7 hysteroscopic morcellators were identified. The diameter of the external sheet ranged from 5.25 to 9.0 mm, optics ranged from 0.8 to 6.3 mm with 0o angle. The cutter device diameter ranged from 2.9 to 4.5 mm most of them with rotation and reciprocation.

Conclusion: We conclude that the adoption of mHTR has shown to reduce operating time, simultaneously cutting and suctioning tissue fragments avoiding the need for multiple removal and reinsertions of the device into the uterine cavity as well as reducing the volume of distension media required to complete the procedure compared to using the hysteroscopic resectoscope.