Laparoscopic Morcellation of Fibroid and Uterus In-Bag

Abstract

Uterine morcellation of presumed leiomyomas inadvertently results in an increase in morcellated uterine leiomyosarcoma (ULMS). Morcellation alters the natural course of ULMS, leading to an increased incidence and earlier recurrences. Recurrences following tumor morcellation are significantly more likely to occur in the peritoneum. Since there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the US FDA (Food and Drug Administration) discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy (US Food and Drug Administration, http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm393576.htm in 2014). In the wake of recent ban on usage of power morcellation by US FDA, we introduce a technique of in-bag morcellation, thus avoiding spillage of tissues in the peritoneal cavity and spread of an undiagnosed disease or cancer or sarcoma. We present a study of twenty-one cases of laparoscopic in-bag morcellation of fibroid and uteri done by Total Health Care method. The in-bag morcellation technique handles the issue of ULMS and makes laparoscopic myomectomy and hysterectomy possible with fair safety. Further studies should be directed toward identifying patients at high risk of ULMS prior to presumed leiomyoma resection in order to reduce the risk of inadvertent tumor morcellation.