Comparison of the Number of Spindle Cells in Peritoneal Washings between Laparoscopic Myomectomy with Morcellation and Open Myomectomy without Morcellation

Abstract

Study Objective: This study evaluated peritoneal washings for the detection of spindle cells (SCs) in laparoscopic and open myomectomies. Design: Prospective, nonrandomized clinical trial. Setting: An academic tertiary referral center. Patients: Women suspected of having benign uterine myoma undergoing laparoscopic or open myomectomy from October 2016 to April 2018.Interventions: Washing of the peritoneal cavity to detect SCs was performed twice during the laparoscopic myomectomy. The first washing was after the closure of the myometrial incision and before morcellation. The second one was performed after morcellation. The procedure was also performed once during the open myomectomy, after the completion of the myomectomy and the closure of the incision. After a peritoneal washing with 200 mL normal saline, 30 mL liquid was collected and sent to the laboratory for SC detection. Surgical parameters such as operating time, mean change in serum hemoglobin level, complications, length of hospital stay, and readmission were compared between the 2 groups. Measurements and Main Results: A total of 150 participants were included in the analysis: 78 in the laparoscopic group and 72 in the open myomectomy group. After morcellation, the incidence of SCs was 2.6% (n = 2) and 6.9% (n = 5) in the laparoscopic and open myomectomy groups, respectively (p = .204). Conclusion: SCs were observed in both the laparoscopic and open myomectomy groups. Thus, morcellation alone could not be the cause for SC dissemination, which might also be triggered by the manipulation of myoma(s).

Fibroid Removal after Myomectomy: An Overview on the Problems of Power Morcellation

“…Asgari et al [ 27 ] evaluated peritoneal dissemination of spindle cells in laparoscopic and open myomectomies. Their prospective, nonrandomized clinical trial included 150 women suspected of UFs submitted to laparoscopic or open myomectomy.…”

Author's Reply

“…There were even more deaths when women underwent conventional open hysterectomy. Also, studies showed spreading cells even in open myomectomy [2].…”