RETIRED: Technical Update on Tissue Morcellation During Gynaecologic Surgery: Its Uses, Complications, and Risks of Unsuspected Malignancy

Is Laparoscopic Power Morcellation of Fibroids a Cardinal Sin in 2017?

“…Uncontained morcellation of leiomyomas during laparoscopic surgery has recently been discouraged, as undetected malignant tumors, namely leiomyosarcomas, could be fragmented which may result in upstaged disease [4]. However, enucleating leiomyomas per se may be inappropriate from an oncological perspective because complete, radical resection of malignant tumors to prevent further tumor growth or recurrence is not achieved.…”

“…Although the incidence of occult leiomyosarcoma is low, outcomes are poor and may be worsened by morcellation [3][4][5]. By addressing risk factors for malignancy and incorporating evolving surgical techniques into practice, gynecologists can continue to offer patients a minimally invasive approach for fibroid management [4,8,23].…”

“…By addressing risk factors for malignancy and incorporating evolving surgical techniques into practice, gynecologists can continue to offer patients a minimally invasive approach for fibroid management [4,8,23]. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates [8,23,24].…”

“…Risk associated with morcellation, however, increases in women age [50 years due to increased leiomyosarcoma rates, an important finding for patient-centered discussions of treatment options for fibroids [23]. Hereditary cancer syndromes that increase the risk of uterine malignancy should be considered a contraindication to uncontained uterine morcellation [4]. Morcellation is an acceptable option for retrieval of benign uterine specimens and may facilitate a minimally invasive surgical approach, which is associated with decreased perioperative risks.…”

“…Although rare, unexpected gynecologic malignancies in presumed fibroids have been documented [1][2][3]. In cases where tissue retrieval is performed through morcellation, there is increasing concern that intra-abdominal dispersion of occult uterine malignancies may lead to peritoneal dissemination and worse outcomes [4]. Gynecologic laparoscopic power morcellation (LPM) has come under increased scrutiny over the last 2 years due to widespread attention to a known but rare complication, an unanticipated dissemination of malignancy, namely occult uterine leiomyosarcoma [5][6][7].…”