In late 2013, a public awareness campaign was initiated after electromechanical morcellation (EMM) of a uterus with presumed benign leiomyoma, which in fact was leiomyosarcoma (LMS). Over the past year, the focus of the medical community has been on the incidence of occult LMS, specifically related to EMM. The risk of intracorporeal tissue dissemination by EMM resulted in some manufacturers halting sales of the EMM device, various hospitals banning the procedure, and ultimately a black box warning from the US Food and Drug Administration (FDA) for electromechanical morcellators.1 This type of issue is not new inmedicine. In the 1950s and early 1960s, laparoscopic surgery was banned in Germany owing to electrosurgical complications during laparoscopic sterilization.2This led togreaterunderstandingof sparking, capacitation, and coupling related to electrosurgery during laparoscopy; subsequent technological improvements and surgeoneducationresulted inelectrosurgerybeingan integralpart ofminimally invasivesurgery today.AlbertEinsteindefined insanity as doing the same thingover andover again andexpecting different results. As with electrosurgery, EMMneeds reassessment and improvement in techniqueand instrumentation for proper use. Systematic literature reviews,3 reports frommultispecialty centers,4 and largegroupstudies5havemainly focusedonhysterectomypatientswithestimationsofuterinesarcomarelating primarily to symptomaticwomenrequiringhysterectomy.This methodologyoverlooks a large data set of patients undergoing myomectomy to restore anatomy and preserve and enhance fertility.6Worldwide,thousandsofmyomectomiesareperformed vaginallyorbyminilaparotomy,conventional laparotomy, laparoscopy, or hysteroscopy, primarily in women of reproductive ageforsubfertility.WhileEMMisusedmostlyduringlaparoscopic myomectomies,withorwithout robotic assistance, the impact andoutcomeof tissuedisruptionat thetimeofmyomectomyby anymethod, including laparotomy, carries a small riskof intraperitoneal dissemination of occultmalignant tissue. In this issue of JAMA Oncology, Wright and colleagues7 report their analysis concerning the prevalence of undetected cancer and precancerous changes in women who underwent myomectomy with and without EMM. In light of the limited data regarding safety and risks in women undergoing myomectomy with EMM, this report broadens the focus on this matter. Owing to lack of information regarding the risk of occult uterine malignant neoplasms in reproductive-age women and possible tumor dissemination during myomectomy, with or withoutmorcellation, themagnitude of harm is unknown. Consequently, not only morcellation, but the prevalence of malignant and premalignant uterine lesions in younger patients, calls for investigation.8 Enbloc removal of allmyomas translates to total hysterectomy,which is inappropriate;myomectomyremains the surgical treatmentof choice in reproductive-agewomenwithsymptomatic uterine fibroids. Patients prefer minimally invasive surgerybecausethebenefitsoutweightheriskswhenperformed appropriately. TheFDAblackboxwarningonpowermorcellatorsmust not cause a reversal to laparotomyor increase in the number of hysterectomies for uterine tumors. Thedemand for reliablemetrics of surgical quality is at an all-time high, calling for a more systematic and rigorous approach toquality improvement. Since there arenoclinical registries formeasuring surgical qualityduringmyomectomy, the report by Wright et al7 opens the door to the use of administrative data. However, there are significant differences between administrative data and clinical registries to measure outcome and surgical quality. Administrative data are pulled fromclaimsprovided to insurers,while clinical registries containdata collected frommedical records,whichquestions the completenessandreliabilityofadministrativedata. Inananalysis of clinical-based data, Graebe et al4 found that morcellation was associated with substantially higher risk of abdominopelvic recurrence and lower disease-free survival, placing a greater emphasis on the magnitude of the problem, not merely the incidence. Comparisonbetweenadministrativedata andclinical registries conducted for predicting surgical results revealed significant differences in both recording and outcomes.9 Creatingandmaintainingaprospectiveregistry isprohibitivelycostly and time consuming compared with gathering administrativedata,which is inexpensive and readily available electronically.However, clinicaldata suchas finalpathology reportsand long-term results supplemented with reliable administrative data is ideal for surgical quality improvement. Improved and individualizedpatient care is dependent on accurate data collection (both clinical and administrative), research, and innovation. “Although data are being collected to quantify and understand these risksmore clearly, aminimally invasivealternative tounenclosed intracorporealmorcellation is favoredwhen available. It is incumbent on surgeons to communicate the risks of practices anddevices and to advocate for continued improvement in surgical instrumentation and techniques.”8(p790) This dilemma requires retrospective analysisandresearchtowardsafersolutions, includingalternatives to unprotected intracorporealmorcellation. Inaddition,developingstrategies tooptimizedatacollectionandgatheringaccurate andreliable informationwill allowclinicians tocounselpatients basedon scientific research tomakeeducateddecisions rather than on fear of the unknown. Related article page 69 Research Original Investigation Underlying Cancer and Precancer in Myomectomy