Biopsy of Uterine Leiomyomata and Frozen Sections Before Laparoscopic Morcellation

Tulandi, Togas; Ferenczy, Alex

doi:10.1016/j.jmig.2014.06.010

Cited by 27 publications

(11 citation statements)

References 14 publications

(18 reference statements)

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“…Laparoscopic myomectomy should be performed for patients with appropriate indications after preoperative evaluation [11]. Gynecologists should pay attention to myomas either that are large (≥ 6.0 cm), especially among postmenopausal women, or that are fast growing or have an abundant blood flow signal in or around the tumor in cases of uterine sarcomas [11,13,14]. Proven or presumed malignant tumors of the uterus are clearly identified as a contraindication for power morcellation.…”

Section: Discussionmentioning

confidence: 99%

“…It can be difficult to identify an unsuspected uterine malignancy through intraoperative assessment [11]. The reliability of frozen section analysis in identifying myometrial disease is controversial [13,15]. Considering the limitations of frozen section histology, an extraction bag or mini‐laparotomy is preferred to extract specimens that show histologically suspicious or even negative results on frozen section analysis to avoid iatrogenic dissemination of malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical characteristics and management experience of unexpected uterine sarcoma after myomectomy

Zhang

Dai

et al. 2015

Intl J Gynecology & Obste

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and management experience of unexpected uterine sarcoma after myomectomy

Zhang

Dai

et al. 2015

Intl J Gynecology & Obste

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“…On the other hand, incisional biopsy of melanoma has no apparent effect on tumour spread [ 70 ]. Tulandi et al [ 55 ] report on two cases of multiple transabdominal biopsies and frozen section before proceeding with morcellation.…”

Section: How To Distinguish a Fibroid From A Sarcoma By Diagnostic Tementioning

confidence: 99%

Options on fibroid morcellation: a literature review

et al. 2015

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In laparoscopy, specimens have to be removed from the abdominal cavity. If the trocar opening or the vaginal outlet is insufficient to pass the specimen, the specimen needs to be reduced. The power morcellator is an instrument with a fast rotating cylindrical knife which aims to divide the tissue into smaller pieces or fragments. The Food and Drug Administration (FDA) issued a press release in April 2014 that discouraged the use of these power morcellators. This article has the objective to review the literature related to complications by power morcellation of uterine fibroids in laparoscopy and offer recommendations to laparoscopic surgeons in gynaecology. This project was initiated by the executive board of the European Society of Gynaecological Endoscopy. A steering committee on fibroid morcellation was installed and experienced ESGE members requested to chair an action group to address distinct clinical questions. Clinical questions were formulated with regards to the sarcoma risk in presumed uterine fibroids, diagnosis of sarcoma, complications of morcellation and future research. A literature review on the different subjects was conducted, systematic if appropriate and feasible. It was concluded that the true prevalence of uterine sarcoma in presumed fibroids is not known given the wide range of prevalences (0.45–0.014 %) from meta-analyses mainly based on retrospective trials. Age and certain imaging characteristics such as ‘lacunes’ suggesting necrosis and increased central vascularisation of the tumour are associated with a higher risk of uterine sarcoma, although the risks remain low. There is not enough evidence to estimate this risk in individual patients. Complications of morcellation are rare. Reported are direct morcellation injuries to vessels and bowel, the development of so-called parasitic fibroids requiring reintervention and the spread of sarcoma cells in the abdominal cavity, which may possibly or even likely upstaging the disease. Momentarily in-bag morcellation is investigated as it may possibly prevent morcellation complications. Because of lack of evidence, this literature review cannot give strong recommendations but offers only options which are condensed in a flow chart. Prospective data collection may clarify the issue on sarcoma risk in presumed fibroids and technology to extract tissue laparoscopically from the abdominal cavity should be perfected.

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“…The lack of specific symptoms, signs or diagnostic techniques for preoperative differentiation from uterine leiomyoma results in most patients being diagnosed after the surgical procedure (either hysterectomy or myomectomy) in apparent early-stage when the hystopathologic examinatios is performed (3). It has been shown that this type of tumors are associated with poor prognosis even when confined to the uterus and even when diagnosed at early stage.…”

Section: Introductionmentioning

confidence: 99%