Morcellation of occulted sarcomas during laparoscopic myomectomy and hysterectomy for patients with large fibroid uterus

Abstract

In April 2014, the United States of America Food and Drug Administration (FDA) published a safety communication warning of the risk of an unsuspected uterine sarcoma being morcellated during a laparoscopic procedure, and advised against the use of power morcellation. In November of the same year, this agency stated: 1) laparoscopic power morcellators are contraindicated for removal of uterine tissue containing suspected fibroids in patients who are peri- or postmenopausal, or are candidates for "en bloc" tissue removal; 2) laparoscopic power morcellators are contraindicated in gynecologic surgery in which the tissue to be morcellated is known or suspected to contain malignancy. In addition, the FDA warned that uterine tissue may contain unsuspected cancer, and the use of laparoscopic power morcellators during fibroid surgery may spread cancer, and decrease the long-term survival of patients. This information should be shared with patients when considering surgery with the use of these devices. In addition, careful consideration should be given to all the available treatment options for women with uterine fibroids. These FDA statements have encouraged the Gynecologists to look for new techniques that allows performing this procedure in a reliable and safer way, decreasing the risk of malignant dissemination thorough the abdominal cavity.