Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review

Abstract

Objective: This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas. Data Sources: Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020. Methods of Study Selection: Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis. Tabulation, Integration, and Results: The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen. Conclusion: Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.

A Novel Multi-Port Containment System for Laparoscopic Power Morcellation to Prevent Tumoral Spread: A Retrospective Cohort Study

“…Only one patient in the study group had a ULSM; it has been followed up for 24 months with no evidence of dissemination. In addition to malignancy, there is a risk of benign tissue spread after unprotected morcellation (5,18,33,34). Four cases were observed in the control group and none in the study group.…”

“…The use of containment systems in power morcellation is accepted worldwide to thwart the spread of occult malignant tumors (5,6). However, owing to the poor compatibility between the extraction bag and the surgical instrument, the bag has a high leakage rate and is not easy to operate.…”

“…Power morcellation facilitates the efficient fragmentation and removal of tissues via small incisions (4). However, unprotective morcellation seriously violates the principle of the no-touch isolation technique and challenges operational safety, thereby becoming a worldwide concern (5,6).…”

The Impact of Laparoscopic Myomectomy on Pregnancy Outcomes: A Systematic Review

“…Bernardi's study [8] reported a significant prevalence of partially intramural, intramural with endometrium contact, and subserous fibroids. In contrast, Pepin [12] and Paul P. G. [11] found a higher occurrence of intramural myomas, while Guangping Wu's study [16] identified a combination of intramural and submucosal myomas as common.…”

“…The average number of myomas per woman varied slightly across studies, with Bernardi, Pepin [12], and Paul P. G. [11] reporting an average of 2 myomas per woman, while Guangping Wu's study [16] observed a higher average of 3.9 myomas.…”