Hysterectomy For Benign Conditions Research Articles

Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study

Effect of Prophylactic Tranexamic Acid in Per-operative and Post-operative Blood Loss in Hysterectomy for Benign Condition: A Randomized Controlled Study

Primary vaginal cancer after hysterectomy for benign conditions: a systematic review of the literature.

Primary vaginal cancer is a rare condition. Some studies have revealed an increased risk of vaginal cancer among patients who have undergone hysterectomy for premalignant and malignant cervical disease. However, there is limited literature available on primary vaginal cancer following hysterectomy for benign conditions. This review aimed to investigate available evidence on clinical characteristics, treatments, and outcomes of primary vaginal cancer following hysterectomy for benign diseases. Additionally, we provide a case of a patient who developed primary vaginal cancer 10 years after undergoing hysterectomy for abnormal uterine bleeding. We conducted a comprehensive literature search on PubMed, Scopus, Web of Science using a combination of title and abstract represented by "hysterectomy", and "vaginal cancer"; "vaginal neoplasm"; and "cancer of vagina". No article type restrictions were applied. Eight studies with a total of 56 cases were included in this review. The main symptom observed was vaginal bleeding. Squamous cancer was found to be the most common type, followed by adenocarcinoma. The majority of vaginal cancer cases occurred approximately 10 years after undergoing hysterectomy. The most common location of the tumor was in the vaginal apex. The management approaches varied and details were available in 25 cases. Among these, 7 cases were treated with radiotherapy alone, 1 case received concurrent chemoradiation therapy, and the of rest of the cases underwent surgery as the primary treatment, with or without additional adjuvant therapy. Data of follow-up was available for 15 cases, with 2 cases resulting in death and 2 cases experiencing recurrence. The other cases were alive and well at the time of considered follow up. Primary vaginal cancer after hysterectomy for benign conditions is an extremely rare condition. It is essential to have high-level evidence to guide the screening and treatment strategy for this rare condition. A part of women who have undergone hysterectomy for benign disorders can benefit from vaginal cytology evaluation. It is reasonable to postpone the initial screening after surgery and to extend the interval between subsequent screenings. Further retrospective case-control trials are expected to determine which specific subgroups of patients mentioned above might most potentially benefit from screening. The treatment decision for vaginal cancer after hysterectomy is more favorable to radiotherapy-based management rather than surgery. Vaginal endometrioid adenocarcinoma may arise from the malignant transformation of endometriosis. More studies are expected to investigate the correlation between these two diseases.

317P Attitudes of Israeli gynecologists towards risk reduction salpingo-oophorectomy at hysterectomy for benign conditions and the use of hormonal therapy

317P Attitudes of Israeli gynecologists towards risk reduction salpingo-oophorectomy at hysterectomy for benign conditions and the use of hormonal therapy

Long-Term Health Consequences After Ovarian Removal at Benign Hysterectomy

More evidence is needed to substantiate current recommendations about removing ovaries during hysterectomy for benign conditions. To compare long-term outcomes in women with and without bilateral salpingo-oophorectomy (BSO) during hysterectomy for benign conditions. Emulated target trial using data from a population-based cohort. Women in Denmark aged 20 years or older during 1977 to 2017. 142985 women with hysterectomy for a benign condition, 22974 with BSO and 120011 without. Benign hysterectomy with or without BSO. The primary outcomes were overall hospitalization for cardiovascular disease (CVD), overall cancer incidence, and all-cause mortality through December 2018. Compared with women without BSO, women with BSO who were younger than 45 years at surgery had a higher 10-year cumulative risk for hospitalization for CVD (risk difference [RD], 1.19 percentage points [95% CI, 0.09 to 2.43 percentage points]). Women with BSO had a higher 10-year cumulative risk for cancer for ages 45 to 54 years (RD, 0.73 percentage point [CI, 0.05 to 1.38 percentage points]), 55 to 64 years (RD, 1.92 percentage points [CI, 0.69 to 3.25 percentage points]), and 65 years or older (RD, 2.54 percentage points [CI, 0.91 to 4.25 percentage points]). Women with BSO had higher 10-year mortality in all age groups, although the differences were statistically significant only for ages 45 to 54 years (RD, 0.79 percentage point [CI, 0.27 to 1.30 percentage points]). The mortality at 20 years was inconsistent with that at 10 years in women aged 65 years or older. Age was a proxy for menopausal status. The authors find that these results support current recommendations for conserving ovaries in premenopausal women without a high risk for ovarian cancer and suggest a cautious approach in postmenopausal women. The Danish Cancer Society's Scientific Committee and the Mermaid Project.

Hysterectomy in benign conditions: a 20-year single-center retrospective on the development of surgical techniques

IntroductionMinimally invasive (MI) surgery has long been established as a standard for hysterectomy in benign conditions. Robotic surgery is generally seen as equivalent to conventional laparoscopy in terms of patient outcome. However, robotics might facilitate an MI approach even in complex patients, rendering laparotomy unnecessary for almost all patients.Materials and methodsWe identified 1939 patients who underwent hysterectomy for benign conditions between 2002 and 2020 at the University Hospital of Essen. Peri- and postoperative data as well as patient characteristics were collected retrospectively.ResultsRobotic surgery, implemented at our institution in 2010, was the most common approach (n = 771; 39.8%). 60.2% of all hysterectomies (1168/1938) were performed using MI techniques. However, there was a significant shift in the methods used for hysterectomy over time. While in 2002 51.4% of all hysterectomies were performed via an open abdominal approach, this percentage dropped to 1.4% in the year 2020. Accordingly, the use of MI approaches increased from 18.9% in 2002 to 98.6% in 2020. The introduction of robotic surgery in 2010 marked a significant shift towards more MI procedures. MI surgery resulted in shorter hospital stay and less postoperative complications compared to laparotomy.On a special note, our cohort includes the largest uterus myomatous uterus in the scientific literature with a specimen weight of 54.8 kg.ConclusionOur data support the hypothesis that the implementation of robotic surgery leads to an improved capability to perform MI surgery and avoid laparotomy in almost all patients. The known benefits of MI surgery could be confirmed.

Attitudes of Israeli gynecologists towards risk reduction salpingo-oophorectomy at hysterectomy for benign conditions and the use of hormonal therapy

ObjectivesTo investigate the perspectives and attitudes of gynecologists towards risk reduction bilateral salpingo-oophorectomy (RRBSO) in average-risk women at the time of hysterectomy procedure for benign indications divided by age groups, and whether they recommend the use of hormonal therapy post oophorectomy. MethodsA questionnaire was distributed during staff meetings either by a printed questionnaire or by a link to a total number of 360 gynecologists include seniors and practitioners. Three hundred and one gynecologists participated in a national survey.Participants completed a structured questionnaire including three different scenarios.The subject group included both attending (senior) and second-year and above resident gynecologists, from divergent subspecialties. The demographic information of the survey responders included sex, age, years of experience, working domain, and subspecialty. ResultsThere was a 95% consensus rate among Israeli gynecologists, in favor of the ovarian conservation approach among 45-year-old women, elected for hysterectomy due to benign indications. Whereas in 50-year-old perimenopause women, without any evident family history of ovarian cancer, 39% of gynecologists advocated BSO at the time of hysterectomy, for benign indications. As for 46-year-old women, with a first-degree relative diagnosed with ovarian cancer at the age of 65 years old, 70.4% voted for prophylactic BSO.For the second part of the questionnaire regarding the utilization of hormone therapy (HT) after BSO, 66.1% of our responders proclaimed they would always encourage the use of HT in 45-year-old-women, while 52.8% recommended HT in 46-year-old-women with a family history of ovarian cancer and 39.5% for 50-year-old perimenopause women. ConclusionOur national survey confirms the wide variability in attitudes among gynecologists towards performing RRBSO at hysterectomy for a benign indication in women aged 45–50, with family history being a major factor in the decision.

Personalising the risk of conversion from laparoscopic to open hysterectomy in benign conditions: Development and external validation of risk prediction models.

To develop and validate novel prediction models to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions. Retrospective cohort study. English NHS Hospitals between 2011 and 2018. 68752 women undergoing laparoscopic hysterectomy for benign conditions. We developed two multivariable logistic models using readily available clinical information, one for the pre-operative setting and another for operative decision-making using additional surgical information, using 2011-2016 data in five regions (24806 women). We validated them (a) temporally in the same regions using 2017-2018 data (12438 women); (b) geographically in the same time-period using data from three different regions (22024 women); and (c) temporally and geographically using 2017-2018 data in three different regions (9484 women). Conversion from laparoscopic to open hysterectomy. Conversions occurred in 6.8% (1687/24806) of hysterectomies in the development group, and in 5.5% (681/12438) in the temporal, 5.9% (1297/22204) in the geographical and 5.2% (488/9484) in the temporal and geographical validation groups. In the development cohort, the area under the receiver operating characteristic curve values for the pre-operative and operative models were 0.65 and 0.67, respectively. In the validation cohorts the corresponding values were 0.65 and 0.66 (temporal), 0.66 and 0.68 (geographical) and 0.65 and 0.68 (temporal and geographical), respectively. Factors predictive of conversion included age, Asian ethnicity, obesity, fibroids, adenomyosis, endometriosis and adhesions. Adhesions were the most predictive (odds ratio 2.54, 95% confidence interval 2.22-2.90). The models for predicting conversions showed acceptable performance and transferability. Novel tool to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions.

Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries

There has been insufficient research on the patient harms and costs associated with potential low-value procedures in the US Medicare population. To report the prevalence of adverse events associated with potential low-value procedures and the additional hospital length of stay (LOS) and costs. This is a retrospective cohort study using Medicare fee-for-service claims between January 2016 to December 2018. Participants were aged 65 years or older. Procedures were selected if they had previously published indicators of low-value care, including knee arthroscopy, spinal fusion, vertebroplasty, percutaneous coronary intervention (PCI), carotid endarterectomy, renal stenting, and hysterectomy for benign conditions. Analysis was conducted from July to December, 2020. For inpatient procedures, the number and rate of admissions with a hospital-acquired condition (HAC) or patient safety indicator event (PSIs), as well as the unadjusted and adjusted difference in mean LOS and Medicare costs between admissions with and without a HAC/PSI. For outpatient procedures, we report the number of claims where the beneficiary had an unplanned hospital admission within seven days and the number of these admissions with a HAC/PSI. There were 573 351 patients included in the study, with 617 264 procedures; the mean (SD) age was 74.2 (6.7) years, with 320 637 women (55.9%), and mostly White patients (520 735; 90.8%). Among the 197 755 claims for the inpatient procedures, 231 had an HAC and 1764 had a PSI. Spinal fusion was associated with the most HACs (123 admissions) and PSIs (1015 admissions). Overall, HACs during a PCI admission were associated with the highest adjusted additional mean LOS (17.5 days; 95% CI, 10.3-23.6), with also the highest adjusted additional mean cost ($22 000; 95% CI, $9100-$32 600). There were 419 509 included outpatient procedures, and 7514 (1.8%) had an unplanned admission within 7 days. A total of 17 HACs and PSIs occurred in these admissions. In this cross-sectional cohort study of Medicare fee-for-service claims, patients receiving potential low-value care were exposed to risk of unnecessary harm associated with higher cost and LOS.

Two different approaches of hysterectomy in benign conditions of uterus without uterovaginal prolapse

Two different approaches of hysterectomy in benign conditions of uterus without uterovaginal prolapse

Indications and Prevalence of Hysterectomy for Benign Conditions at a Tertiary Care Hospital in Rural South India–A Descriptive Study

This study aims to assess the indications and prevalence often various types of hysterectomy done for benign diseases. It was a retrospective descriptive study conducted at the Department of Obstetrics and Gynaecology in Saveetha Medical College and Hospital, Thandalam. Data about the hysterectomies done for benign conditions were obtained from January 2019 till December 2019 from the in-hospital medical registry. Demographics, presenting complaints, indications, history, type of hysterectomy and complications were analysed. Amongst the two hundred (200) cases of hysterectomy performed in the year 2019, total abdominal hysterectomy (69%) was the most standard type and Leiomyoma uterus (73.5%) being the most common indication. Bilateral Salphingo-Oophorectomy (55%) was done in most patients, along with hysterectomy. Due to the advent of safer surgical practices, the extent of complications have drastically reduced, excessive bleeding (13.5%) being the most common, surgical site infection (1.5%) and bladder injury (1.5%) were recorded. This study demonstrates that though the incidence of hysterectomy done for benign conditions is decreasing with increasing popularity to go for medical management, women in rural India are still opting for surgical management. This necessitates the need for studies to analyse the psychological aspect governing the acceptance of surgical management in preference to conservative management in these rural women.

Risk of incidental genital tract malignancies at the time of myomectomy and hysterectomy for benign conditions.

ObjectiveTo determine the incidence of accidentally diagnosed genital malignancies in women undergoing gynecological surgeries for pathologies presumed to be benign.MethodsData of all women who underwent hysterectomy for benign indications were retrieved from hospital records. A total of 628 cases of hysterectomy and 35 cases of myomectomy were included. The final histopathology was accessed through the computer records, and the total number of genital tract malignancies was included.ResultsThe incidence of occult uterine, ovarian, and cervical malignancies in women undergoing hysterectomy was 0.47%, 0.31%, and 0.15%, respectively. The incidence of uterine corpus malignancies in women undergoing myomectomy was 2.8%, and 3 cases of smooth muscle tumor of uncertain malignant potential (STUMP) were also identified. Endometrial stromal sarcomas were the most common pathology among uterine malignancies, followed by leiomyosarcoma and endometrial adenocarcinoma.ConclusionPostoperative diagnosis of malignancies in women undergoing surgery for benign indications poses great challenges to the treating surgeon. Occult malignancies must be ruled out by thorough preoperative assessment, especially in some subsets of women. Morcellation is an inevitable technique and complement to laparoscopic surgeries, although little chances of malignancy spread is related to its use. Nevertheless, thorough preoperative investigations and always ensuring contained morcellation can minimize these chances.

Bilateral Salpingo-Oophorectomy at the time of hysterectomy for benign conditions: Patterns and factors influencing procedure rate

Bilateral Salpingo-Oophorectomy at the time of hysterectomy for benign conditions: Patterns and factors influencing procedure rate

Ovarian removal at or after benign hysterectomy and breast cancer: a nationwide cohort study.

Large-scale population-based registry studies investigating the risk of breast cancer after removal of both ovaries at hysterectomy for benign conditions in women with no known genetic predisposition to cancer are needed. We aimed to perform such a study taking into account the age at surgery status and use of hormone replacement therapy (HRT). Within the female population of Denmark born 1937-1996, we evaluated breast cancer incidence after unilateral or bilateral oophorectomy concomitant with or after benign hysterectomy in comparison with no surgery and with hysterectomy alone using health registry data during 1978-2016. In a subpopulation followed from 1996, the analyses were stratified according to use of HRT. We found a reduced risk of breast cancer among women aged < 45years at bilateral oophorectomy compared with women with hysterectomy alone (HR = 0.78; 95% CI 0.66, 0.92), whereas slightly increased risks were seen in women above 50years. In the subpopulation, non-users of HRT aged ≥ 50years at oophorectomy had a HR of 0.74 (95% CI 0.56, 0.98) for breast cancer after bilateral oophorectomy compared with hysterectomy alone. Our large-scale study covering four decades provides evidence that bilateral oophorectomy performed at young age in women with benign indications for hysterectomy is associated with a reduction in breast cancer risk. The finding of a negative association at older ages in women not using HRT deserves further attention.

Evaluating the Incidence of Urinary Tract Infection after Hysterectomy for Benign Conditions

Study Objective To report rates and identify risk factors for urinary tract infection (UTI) following hysterectomy for benign conditions. Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patients or Participants Women undergoing benign hysterectomy by any modality between 2010 and 2017. Interventions Abdominal hysterectomy (AH), total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy (LAVH), vaginal hysterectomy (TVH). Measurements and Main Results 67,243 women included in the analysis with 1,310 postoperative UTIs identified, at a rate of 19.5 per 1000 hysterectomies. Women who developed UTIs were more likely to smoke (19.6% vs 15.7%, p= Procedures complicated by UTI were longer (148.1min +/-79.4 vs 135.5min +/-65.6, p= Following regression analysis, cystotomy (aOR=4.16, 95%CI=2.57-6.73) and TVH (aOR=2.45, 95%CI=1.99-2.99) were significant independent predictors of associated with an increased risk of post-hysterectomy UTI. Conclusion The risk of UTI after hysterectomy is low. Intraoperative cystotomy and vaginal hysterectomy are the most significant predictors of subsequent urinary tract infection.

2180 Experience of Centro Medico Nacional “20 De Noviembre“ in Robotic-assisted Hysterectomy for Large Uteri: A Case Series of 20 Women

Study Objective To determine the outcomes of robotic-assisted laparoscopic hysterectomy for benign conditions in women with large uteri. Design A prospective and recruting cases for robotic-assisted laparoscopic hysterectomy for benign indications at Centro Medico Nacional “20 de Noviembre” by one surgeon with trainning in minimally invasive and Robotic surgery between May 2016 to August 2018. Setting Centro Medico Nacional “20 de Noviembre” ISSSTE. Patients or Participants Only women with large uteri (defined as greater than 750g) were included in this study. Interventions Robotic hysterectomy. Measurements and Main Results A total of 20 women were included in the analysis: 11 patients had uterine weights 750-999g and 9 had uterine weights greater than 1000g with the largest being 1,450g. The average surgical times were 131 min (53-301 min) and 156 min (82-338 min), respectively. The average estimated blood loss was 50cc; no blood transfusions were required. There were no intra- operative conversions. There were none major intraoperative complications. There were 2 minor postoperative complications (acute urinary retention and a wound dehiscence of an umbilical port site); both were in the 750-999g group. All patients in both groups were hospitalized 0-1 days. Conclusion In skilled hands, robotic-assisted laparoscopic hysterectomy in women with large uteri is an acceptable option, associated with minimal complications.

2897 Sleep, Fatigue, and Life Satisfaction After Hysterectomy in Women with Preoperative Pain and Depression

Study Objective To examine differences in life satisfaction, sleep, and fatigue after hysterectomy among women with preoperative pelvic pain and/or depression. Design Secondary data analysis of a prospective, observational cohort study of women undergoing hysterectomy for benign conditions. Setting Academic tertiary care center. Patients or Participants 336 patients undergoing hysterectomy for benign indications. Interventions Patients completed validated assessments of life satisfaction, sleep, and fatigue preoperatively and 6-months after hysterectomy. Patients were divided into four groups based on preoperative characteristics: pelvic pain only, depression only, pain + depression, and no pain or depression. Presence of pelvic pain was defined as average pelvic pain score of ≥ 4 (on numerical rating scale 0-10) at baseline survey. Measurements and Main Results Preoperatively, women with pelvic pain only reported worse sleep (p=0.01) and fatigue (p At 6-month follow-up, women with pelvic pain only reported significant improvements in life satisfaction (p=0.04), sleep (p Conclusion Women with pre-existing pelvic pain only demonstrate improvements in life satisfaction, sleep disturbance, and fatigue following hysterectomy and achieve similar levels to those with no pain or depression. Women with coexisting depression fare significantly worse in these domains than those without.

Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

BackgroundThe aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions.MethodsCost-minimization analysis based on an analytic observational study of prospective cohorts with a five-year time horizon. Eligible participants were all female adults scheduled for total laparoscopic hysterectomy for benign conditions at tertiary hospital. The economic evaluation was conducted from a Spanish National Health Service and societal perspective, including healthcare costs and indirect costs. The costs are expressed in Euros from the year 2015.ResultsOne hundred sixty nine patients were analyzed, 68 in the RAH group and 101 in the CLH group. Average cost for the RAH group was €8982.42 compared to €8015.14 for the CLH group (incremental cost €967.27; p = 0.054). Healthcare cost is the most important component of total cost and represents 86.4% for the RAH group and 82.3% for the CLH group. The difference of €1169 (p = 0.01) in the average healthcare cost is mainly due to the cost of purchasing and maintaining the equipment (difference of €1206.39 in favor of RAH; p < 0.005). With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower (difference of €203.42; p = 0.17), while the cost of trips to the hospital was higher (difference of €1.98; p = 0.66) in respect to CLH.ConclusionsOur findings reveal similar effectiveness between RAH and CLH, although CLH is the more efficient option from the point of view of an economic analysis based on cost-minimization.

Application of failure mode and effect analysis in total laparoscopic hysterectomy in benign conditions.

Hysterectomy is the most common major gynecological operation in developed countries. The rate of intraoperative complications related to the laparoscopic approach during hysterectomy is a relevant issue. The failure mode and effect analysis (FMEA) method is a prospective approach, which tries to identify possible errors before they occur. In this study we applied the FMEA method to laparoscopic approach to hysterectomy in order to reduce the theorized risk of intraoperative complications. We selected a team who analyzed and deconstructed the total laparoscopic hysterectomy (TLH) process recording on the FMEA worksheet phases and activities of the entire procedure. Each activity-related failure mode and their potential effects were developed. The team also described actions to eliminate or decrease the likelihood of mistakes. A numerical value reflecting the risk was assigned to each activity. Five activities were identified as high priority risk, and for each activity actions were then taken to mitigate the identified risk. After introduction of these actions, the risk scores for each activity were recalculated, and we obtained a total risk reduction of 55%. It is our opinion that the systematic implementation of the FMEA model can reduce the risk of human error during laparoscopic surgery, improving patient safety.

A value-based evaluation of minimally invasive hysterectomy approaches

BackgroundWith surgical care contributing to the rising healthcare costs around the globe, quantifying the value of surgical modalities is critical to pushing healthcare systems in the direction of greater sustainability. The purpose of this study was to assess and compare the value of minimally invasive hysterectomy approaches, as defined by operative outcomes and patient satisfaction relative to direct hospital costs.MethodsSequential mixed methods; retrospective chart review of all women (N = 2689) ≥ 18 years old who underwent hysterectomy for benign conditions from 2011 through 2013 at a suburban hospital in Maryland, USA; a mail survey of the same population was administered in June to October 2015. Procedures included laparoscopic supracervical hysterectomy (LSH), robotically assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), laparoscopically assisted vaginal hysterectomy (LAVH), total vaginal hysterectomy (TVH), and laparoscopic retroperitoneal hysterectomy (LRH), a procedure that incorporates retroperitoneal dissection and ligation of the uterine arteries at their vascular origin. We estimated the value of each procedure by dividing quality over direct hospital costs, where quality was quantified by creating a summary composite score of the average operating time, estimated blood loss, complication and conversion rates, and patient satisfaction.ResultsThe majority of LRH and RALH procedures were performed by high-volume surgeons, while the majority of LSH and TVH procedures were performed by low-volume surgeons. RALH had the highest postoperative complication rate (11.4%; p < .0001). TVH had the highest intraoperative complication rate (9.6%; p < .0001) but lowest postoperative complication rate (1.8%; p < .0001). LRH had the shortest operating time (71.2 min; p < .0001) and lowest intraoperative complication rates (2.1%; p < .0001). LRH and TVH were the least costly ($4061 and $6416, respectively), while RALH was the most costly ($9354). LRH had the highest combined patient satisfaction score, followed by RALH, while TLH, LAVH, TVH, and LSH averaged similar scores.ConclusionLRH, TVH, and LAVH yielded the highest value scores; LSH, TLH, and RALH yielded the lowest. Healthcare costs continue to escalate, in large part due to innovations in medical technology. For healthcare stakeholders seeking to control costs without sacrificing quality, it is critical to operationalize the value of varying surgical techniques, including measures of surgeon experience, operative outcomes, costs, and patient satisfaction.

Occult Malignancy Rate of 1498 Hysterectomies or Myomectomies with Morcellation: A Retrospective Single-Arm Study.

Since April 2014, the FDA warns against the use of morcellation during minimally invasive uterine surgery because of the risk of occult malignant spreading in the abdominal cavity. It is clear, however, that more studies are needed to define the incidence of occult uterine cancers, its risk factors, preoperative identification and postoperative follow-up. The present retrospective single-arm study defines the prevalence of occult uterine malignancies in a large group of patients treated with hysterectomy or myomectomy for benign indications. In the year of 2014, 1498 women admitted for a myomectomy or hysterectomy in benign conditions at the clinic of minimally invasive surgery (Minimal Invasive Chirurgie or MIC) in Berlin (Germany) were included in this study. The morcellated uterine specimens of operated patients were histologically analyzed for the presence of cancerous tissue. We detected malignancies in three of the 1498 women (0.2%): two patients had endometrial cancer, while we observed cervical cancer in situ in the third patient. No sarcoma was found. We detected a very low prevalence of occult uterine malignancy which is in line with several other recent studies. To define a clear policy on the use of morcellation, more studies are required. In the meantime, patients should be informed about the risks of morcellation in case of undetected cancer prior to surgery.