Abstract
BackgroundWidespread concerns have been raised regarding the safety of power morcellation of uterine specimens because of the potential to disseminate occult malignancy. We sought to assess the safety and feasibility of contained manual uterine morcellation within a plastic specimen bag among women with uterine neoplasms.MethodsA retrospective single-institution descriptive cohort study was conducted from 2003 to 2014. Patients with leiomyoma and/or uterine malignancy who underwent minimally invasive surgery with contained uterine manual morcellation were identified from surgical logs. Demographic data, pathology results, operative details and adjuvant treatments were abstracted.ResultsEighty-eight patients were identified; 35 with leiomyoma and 53 with endometrial cancer. The mean age was 48 and 60, respectively. Uterine size/weight was greater in women with leiomyoma compared to those with cancer (15.1 weeks/448 g vs. 10.7 weeks/322 g). Mean operative time was 206 min (range 115–391) for leiomyoma cases and 238 min (range 131–399) for cancer cases. Median length of stay was 1 day (range 0–3 days). There were no cases of occult leiomyosarcoma and all specimens were successfully manually morcellated within a bag. There were no intraoperative complications. Thirty-day postoperative complications occurred in 7 patients, including one readmission for grade (G) 1 vaginal cuff separation after intercourse, G1 port-site hematoma (1), G2 port-site cellulitis (1), G2 vaginal cuff cellulitis (2), G2 bladder infection (2), G2 pulmonary edema (1), and G1 musculoskeletal injury (1).ConclusionsContained uterine hand morcellation is a feasible procedure with low peri-operative complication rates that allows for minimally invasive surgical procedures for women with large uterine neoplasms. Further evaluation is needed to assess survival outcomes for uterine malignancies.
Highlights
Widespread concerns have been raised regarding the safety of power morcellation of uterine specimens because of the potential to disseminate occult malignancy
Minimally invasive surgery (MIS) for hysterectomy provides patients with an alternative to laparotomy, for uteri enlarged by leiomyomas or malignancy that are not amenable to vaginal hysterectomy
The prevalence of occult uterine malignancy in patients with suspected leiomyoma is not known exactly, but multiple retrospective studies have estimated rates of malignancy at 0.2–1% in women undergoing uterine morcellation [5] compared to 0.23–0.49% in non-morcellated specimens [6]
Summary
Widespread concerns have been raised regarding the safety of power morcellation of uterine specimens because of the potential to disseminate occult malignancy. Concerns about the dissemination of undiagnosed uterine cancer using power morcellation have been raised. In November 2014, the FDA released a safety communication defining contraindications to power uterine morcellation: 1) removal of suspected fibroid tissue in peri- and postmenopausal women who are candidates for en-bloc resection (vaginal or via mini-laparotomy), and 2) removal of tissue known or suspected to contain malignancy [4]. The prevalence of occult uterine malignancy in patients with suspected leiomyoma is not known exactly, but multiple retrospective studies have estimated rates of malignancy at 0.2–1% in women undergoing uterine morcellation [5] compared to 0.23–0.49% in non-morcellated specimens [6]. Despite the low probability of malignancy, the risk of tumor dissemination has caused significant concerns regarding power morcellation, a moratorium of the procedure at select centers, and removal of some morcellation devices from the market
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