Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-8448b6f56d-dnltx Total loading time: 0 Render date: 2024-04-19T23:05:00.426Z Has data issue: false hasContentIssue false

Chapter 10 - Uterine Fibroids

The Morcellation Debate

Published online by Cambridge University Press:  10 October 2020

By
Jimena B. Alvarez  and
Charles E. Miller
Edited by
Mostafa Metwally  and
Tin-Chiu Li
Mostafa Metwally
Affiliation:
University of Sheffield
Tin-Chiu Li
Affiliation:
The Chinese University of Hong Kong
Get access

Summary

One of the risks of electronic power morcellation, central to the morcellation debate, is the concern of spread of malignant uterine tissue. Uterine cancer is the most common gynaecologic cancer in the United States with an estimated 49,560 cases and 8,190 deaths in 2013. Uterine sarcomas arise from the mesodermal tissues of the uterine body and account for 3% of all uterine cancers, and represent 3.3 cases per 100,000 women [1]. Leiomyosarcoma (LMS) represents 40% of all uterine sarcomas, and 2% of all uterine malignancies, and the annual incidence has been estimated to be 0.64 per 100,000 women [2]. It can present at any age, but most commonly between 45 and 55 years old, and its prevalence increases by 10% in patients over 60 years old.

Type
Chapter
Information
Modern Management of Uterine Fibroids , pp. 90 - 98
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benoit, M, Williams-Brown, MY, Edwards, C. Gynecologic Oncology Handbook: An Evidence-Based Clinical Guide. Demos Medical Publishing, LLC; 2013.Google Scholar
American Cancer Society. Uterine Sarcoma. Atlanta, GA: American Cancer Society; 2013.Google Scholar
Goto, A, Takeuchi, S, Sugimura, K, Maruo, T. Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer 2002;12(4):354–61.Google Scholar
Nieboer, TE, Johnson, N, Lethaby, A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;(3):Cd003677.Google Scholar
Amir, Wiser A, Holcroft, C, Tulandi, T, Abenhaim, H. Abdominal versus laparoscopic hysterectomies for benign diseases: evaluation of morbidity and mortality among 465,798 cases. Gynecol Surg 2013;10(2):117–22.Google Scholar
American College of Obstetricians and Gynecologists. Choosing the route of hysterectomy for benign disease. Committee Opinion No. 444. Obstet Gynecol 2009;114:1156–8.Google Scholar
AAGL, Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol 2011;18(1):1–3.CrossRefGoogle Scholar
Parker, WH, Kaunitz, AM, Pritts, EA, et al. U.S. Food and Drug Administration’s guidance regarding morcellation of leiomyomas: well-intentioned, but is it harmful for women? Obstet Gynecol 2016;127(1):18–22.CrossRefGoogle ScholarPubMed
Brown, J. AAGL advancing minimally invasive gynecology worldwide: statement to the FDA on power morcellation. J Minim Invasive Gynecol 2014;21(6):970–1.Google Scholar
Allen, E. Vaginal removal of the uterus by morcellation. Am J Obstet Gynecol 1949;57(4):692–700.Google Scholar
Hasson, HM, Rotman, C, Rana, N, Sistos, F, Dmowski, WP. Laparoscopic myomectomy. Obstet Gynecol 1992;80(5):884–8.Google Scholar
Steiner, RA, Wight, E, Tadir, Y, Haller, U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 1993;81(3):471–4.Google ScholarPubMed
Carter, JE, McCarus, SD. Laparoscopic myomectomy. Time and cost analysis of power vs. manual morcellation. J Reprod Med 1997;42(7):383–8.Google ScholarPubMed
Schneider, A. Recurrence of unclassifiable uterine cancer after modified laparoscopic hysterectomy with morcellation. Am J Obstet Gynecol 1997;177(2):478–9.CrossRefGoogle ScholarPubMed
Seidman, MA, Oduyebo, T, Muto, MG, et al. Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS One 2012;7(11):e50058.Google Scholar
Society of Gynecologic Oncology. SGO Position Statement: Morcellation. 2013. Available at: www.sgo.org/newsroom/position-statements-2/morcellation/. Accessed 1 Dec 2016.Google Scholar
Goff, BA. SGO not soft on morcellation: risks and benefits must be weighed. Lancet Oncol 2014;15(4):e148.CrossRefGoogle Scholar
FDA Safety Communication. Laparoscopic uterine power morcellation in hysterectomy and myomectomy. Apr 2014. Available at: www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm393576.htm. Accessed 1 Dec 2016.Google Scholar
FDA. Quantitative assessment of the prevalence of unsuspected uterine sarcoma in women undergoing treatment of uterine fibroids. Apr 2014. Available at: www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM393589.pdf. Accessed 1 Dec 2016.Google Scholar
AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol. 2017;21(4):517–30.Google Scholar
FDA Safety Communication. Updated laparoscopic uterine power morcellation in hysterectomy and myomectomy. Nov 2014. Available at: www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm. Accessed 1 Dec 2016.Google Scholar
Siedhoff, MT, Wheeler, SB, Rutstein, SE, et al. Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroid tumors in premenopausal women: a decision analysis. Am J Obstet Gynecol 2015;212(5):591.e591–8.Google Scholar
Pritts, EA, Vanness, DJ, Berek, JS, et al. The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. Gynecol Surg 2015;12(3):165–77.CrossRefGoogle ScholarPubMed
Bojahr, B, De Wilde, RL, Tchartchian, G. Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LASH). Arch Gynecol Obstet. 2015;292(3):665–72.Google Scholar
Harris, JA, Swenson, CW, Uppal, S, et al. Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation. Am J Obstet Gynecol 2016;214(1):98.e91–98.e13.Google Scholar
Barron, KI, Richard, T, Robinson, PS, Lamvu, G. Association of the U.S. Food and Drug Administration morcellation warning with rates of minimally invasive hysterectomy and myomectomy. Obstet Gynecol 2015;126(6):1174–80.Google Scholar
Wright, J, Chen, L, Burke, W, et al. Trends in use and outcomes of women undergoing hysterectomy with electric power morcellation. JAMA 2016;316(8):877–8.Google Scholar
Cohen, SL, Einarsson, JI, Wang, KC, et al. Contained power morcellation within an insufflated isolation bag. Obstet Gynecol 2014;124(3):491–7.Google Scholar
Steller, C, Miller, C, Sasaki, K, Cholkeri-Singh, A. Review and outcome of electromechanical power morcellation using an innovative contained specimen bag system. J Minim Invasive Gynecol 2015;22(6):S100–1.Google Scholar
Seidman, DS, Nezhat, CH, Nezhat, F, Nezhat, C. The role of laparoscopic-assisted myomectomy (LAM). J Soc Laparoendosc Surg 2001;5(4):299–303.Google ScholarPubMed
Nezhat, C, Nezhat, F, Bess, O, Nezhat, CH, Mashiach, R. Laparoscopically assisted myomectomy: a report of a new technique in 57 cases. Int J Fertil Menopausal Stud 1994;39(1):39–44.Google Scholar
Serur, E, Zambrano, N, Brown, K, Clemetson, E, Lakhi, N. Extracorporeal manual morcellation of very large uteri within an enclosed endoscopic bag: our 5-year experience. J Minim Invasive Gynecol 2016;23(6):903–8.Google Scholar
Park, JY, Park, SK, Kim, DY, et al. The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 2011;122(2):255–9.Google Scholar
Perri, T, Korach, J, Sadetzki, S, et al. Uterine leiomyosarcoma: does the primary surgical procedure matter? Int J Gynecol Cancer 2009;19(2):257–60.Google Scholar
Morice, P, Rodriguez, A, Rey, A, et al. Prognostic value of initial surgical procedure for patients with uterine sarcoma: analysis of 123 patients. Eur J Gynaecol Oncol 2003;24(3–4):237–40.Google Scholar
Oduyebo, T, Rauh-Hain, AJ, Meserve, EE, et al. The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol 2014;132(2):360–5.Google Scholar
Kho, KA, Nezhat, CH. Evaluating the risks of electric uterine morcellation. JAMA 2014;311(9):905–6.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×