Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation: Our Experience

Graziano, Angela; Monte, Giuseppe Lo; Hanni, Herbert; Brugger, Johann Georg; Engl, Bruno; Marci, Roberto

doi:10.1016/j.jmig.2014.09.013

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…As novel methods of laparoscopic tissue removal develop, these changes in surgical practice may shift back toward laparoscopic surgery, and the current trends may not prove to be long-lasting. [12][13][14][15][16][17][18][19][20] The study found an association between the FDA morcellation safety communication and surgical morbidity for patients. We found a 27% increase in major, nonblood transfusion, postoperative complications following the FDA safety communication, as well as a 25% increase in hospital readmissions.…”

Section: Commentmentioning

confidence: 99%

Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation

Harris

Swenson

Uppal

et al. 2016

American Journal of Obstetrics and Gynecology

127

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Section: Commentmentioning

confidence: 99%

Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation

Harris

Swenson

Uppal

et al. 2016

American Journal of Obstetrics and Gynecology

127

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“…Priority was placed on identifying large population-based cohort studies reporting long-term rates. This yielded three 5,46,49 population-based cohort studies reporting rates of hysterectomy following EA and eight 17,[50][51][52][53][54][55][56] smaller observational studies reporting rates of further surgery following LASH (see Appendix 4 for details).…”

Section: Extrapolation Of Subsequent Hysterectomy Following Endometrimentioning

confidence: 99%

“…This process yielded three large population-based cohort studies 5,46,49 reporting the incidence of further surgery following EA and three smaller cohort studies reporting on rates of subsequent surgery following LASH. [54][55][56] The two non-randomised comparative studies identified above 53,72 were added to this pool, as were three additional studies identified through the reference lists of other included studies, [50][51][52] providing a total of eight observational studies of potential use for informing rates of post-LASH surgery in the model.…”

Section: Imputation Modelmentioning

confidence: 99%

“…Graziano et al 54 reported on mainly perioperative and early postoperative complications occurring in 365 women undergoing LASH, but also reported one later vaginal trachelectomy and operative laparoscopies (n = 4) performed beyond 6 months. 54 However, the precise follow-up time for these further procedures was not reported. Schuster et al 55 reported that 5 out of 277 (1.8%) women undergoing LASH in a single Canadian centre had a repeat operative procedure for pain or bleeding.…”

Section: Imputation Modelmentioning

confidence: 99%

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Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual bleeding: the HEALTH RCT

Cooper

Breeman

Scott

et al. 2019

Health Technol Assess

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Background Heavy menstrual bleeding (HMB) is a common problem that affects many British women. When initial medical treatment is unsuccessful, the National Institute for Health and Care Excellence recommends surgical options such as endometrial ablation (EA) or hysterectomy. Although clinically and economically more effective than EA, total hysterectomy necessitates a longer hospital stay and is associated with slower recovery and a higher risk of complications. Improvements in endoscopic equipment and training have made laparoscopic supracervical hysterectomy (LASH) accessible to most gynaecologists. This operation could preserve the advantages of total hysterectomy and reduce the risk of complications. Objectives To compare the clinical effectiveness and cost-effectiveness of LASH with second-generation EA in women with HMB. Design A parallel-group, multicentre, randomised controlled trial. Allocation was by remote web-based randomisation (1 : 1 ratio). Surgeons and participants were not blinded to the allocated procedure. Setting Thirty-one UK secondary and tertiary hospitals. Participants Women aged < 50 years with HMB. Exclusion criteria included plans to conceive; endometrial atypia; abnormal cytology; uterine cavity size > 11 cm; any fibroids > 3 cm; contraindications to laparoscopic surgery; previous EA; and inability to give informed consent or complete trial paperwork. Interventions LASH compared with second-generation EA. Main outcome measures Co-primary clinical outcome measures were (1) patient satisfaction and (2) Menorrhagia Multi-Attribute Quality-of-Life Scale (MMAS) score at 15 months post randomisation. The primary economic outcome was incremental cost (NHS perspective) per quality-adjusted life-year (QALY) gained. Results A total of 330 participants were randomised to each group (total n = 660). Women randomised to LASH were more likely to be satisfied with their treatment than those randomised to EA (97.1% vs. 87.1%) [adjusted difference in proportions 0.10, 95% confidence interval (CI) 0.05 to 0.15; adjusted odds ratio (OR) from ordinal logistic regression (OLR) 2.53, 95% CI 1.83 to 3.48; p < 0.001]. Women randomised to LASH were also more likely to have the best possible MMAS score of 100 (68.7% vs. 54.5%) (adjusted difference in proportions 0.13, 95% CI 0.04 to 0.23; adjusted OR from OLR 1.87, 95% CI 1.31 to 2.67; p = 0.001). Serious adverse event rates were low and similar in both groups (4.5% vs. 3.6%). There was a significant difference in adjusted mean costs between LASH (£2886) and EA (£1282) at 15 months, but no significant difference in QALYs. Based on an extrapolation of expected differences in cost and QALYs out to 10 years, LASH cost an additional £1362 for an average QALY gain of 0.11, equating to an incremental cost-effectiveness ratio of £12,314 per QALY. Probabilities of cost-effectiveness were 53%, 71% and 80% at cost-effectiveness thresholds of £13,000, £20,000 and £30,000 per QALY gained, respectively. Limitations Follow-up data beyond 15 months post randomisation are not available to inform cost-effectiveness. Conclusion LASH is superior to EA in terms of clinical effectiveness. EA is less costly in the short term, but expected higher retreatment rates mean that LASH could be considered cost-effective by 10 years post procedure. Future work Retreatment rates, satisfaction and quality-of-life scores at 10-year follow-up will help to inform long-term cost-effectiveness. TriaI registration Current Controlled Trials ISRCTN49013893. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 53. See the NIHR Journals Library website for further project information.

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“…However, no data exist to show decreased survival or poorer clinical course when other types of tumors undergo morcellation, including electromechanical morcellation. A systematic review of cases from 1980 to 2016 [15,16,[31][32][33][34][35][36][37][38][39][40][41] revealed 19 patients who underwent inadvertent morcellation of endometrial adenocarcinomas. Of the 18 who underwent power morcellation, there were no recurrences.…”

Section: Impact Of Morcellation On Tissue Dissemination and Survivalmentioning

confidence: 99%

Morcellation during Uterine Tissue Extraction: An Update

2018

Journal of Minimally Invasive Gynecology

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Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation: Our Experience

Cited by 6 publications

References 27 publications

Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation

Practice patterns and postoperative complications before and after US Food and Drug Administration safety communication on power morcellation

Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual bleeding: the HEALTH RCT

Morcellation during Uterine Tissue Extraction: An Update

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