Single port access laparoscopic subtotal hysterectomy using contained manual morcellation: Experience from a tertiary referral center in Taiwan

Weng, Shih-Shien; Chou, Yi-Chun; Sun, Fang‐Ju

doi:10.1016/j.tjog.2017.12.005

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…After the US Food and Drug Administration (FDA) warning in April 2014 (Solima et al 2015 ), there was a subsequent shift of management strategies from the use of MIS to the use of open abdominal procedures, along with significantly more major and minor complications (Multinu et al 2018 ). In order to maintain the benefits of MIS, the method of using a power morcellator or manual extraction to remove the specimen from inside of the bag has been more and more prevalent (Devassy et al 2019 ; Weng et al 2018 ).…”

Section: Discussionmentioning

confidence: 99%

The incidence of unexpected uterine malignancies in hysterectomies carried out for benign indications

Ding

Han

Zhang

et al. 2022

J Cancer Res Clin Oncol

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Purpose The aim of the present study was to evaluate the incidence of unexpected uterine malignancies in patients undergoing hysterectomy for benign indications and to evaluate their clinical characteristics. Methods We conducted a retrospective review of patients who underwent benign hysterectomy in the Department of Gynecology, the First Hospital of Shanxi Medical University from January 2015 to December 2020. The clinical data of these patients were retrieved and collected. Results Their median age was 49.8 years (31–82 years). The mean parity was 1.86 ± 2.54. Their mean BMI was 27.5 ± 7.6 kg/m2. 42.90% were (2438/5683) postmenopausal. The benign indications of procedure were as follows: symptomatic uterine leiomyomas 2218/5683 (39.02%), pelvic organ prolapse 1406/5683 (24.74%), symptomatic endometriosis or adenomyosis 1132/5683 (19.91%), and 927/5683 (16.31%) to treat other benign conditions such as abnormal uterine bleeding, infection, polyps, and endometrial hyperplasia without atypia. In minimally invasive surgery subgroups, 1560/2621 (59.52%) specimens were removed by in-bag manual morcellation through vaginal cuff. The mean operative time of minimally invasive surgery with in-bag morcellation was shorter than abdominal hysterectomy (96.75 ± 35.7 vs. 140 ± 32.6, P < .001), and the estimated blood loss was also less than abdominal hysterectomy (47.35 ± 42.3 vs. 170 ± 60.4, P < .001). A total of 19/5683 (0.33%) unexpected uterine malignancies were recorded, of which 14/5683 (0.26%) were unexpected endometrial carcinomas and 5/5683 (0.08%) were unexpected uterine sarcomas. Conclusion Preoperative examination in the context of benign hysterectomy must be undertaken with care, and patients should be educated about the very slight possibility of a malignant diagnosis.

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Section: Discussionmentioning

confidence: 99%

The incidence of unexpected uterine malignancies in hysterectomies carried out for benign indications

Ding

Han

Zhang

et al. 2022

J Cancer Res Clin Oncol

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“…Ultimately, given the exceedingly rare frequency of occult malignancy or malignant transformation of benign processes, balanced and comprehensive informed consent is required. Furthermore, alternatives to unconfined power morcellation which still permit minimally invasive laparoscopic surgery may be considered [17,18].…”

Section: Case Reports In Obstetrics and Gynecologymentioning

confidence: 99%

Disseminated Endometriosis and Low-Grade Endometrioid Stromal Sarcoma in a Patient with a History of Uterine Morcellation for Adenomyosis

Stefanko

Eskander

Aisagbonhi

2020

Case Reports in Obstetrics and Gynecology

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Morcellation of benign uterine tumors allows for removal of the tumors via minimally invasive laparoscopic procedures. However, in rare cases, morcellation has been associated with upstaging of unexpected malignancies. Morcellation has also been associated with dissemination of benign pathologic processes such as endometriosis and leiomyomas. Endometrial stromal sarcoma typically arises in the uterine cavity, although cases of extrauterine endometrioid stromal sarcoma arising out of foci of endometriosis have been reported. Dissemination of endometrial stromal sarcomas can be an unintended consequence of morcellation procedures, as can dissemination of endometriosis, from which endometrioid stromal sarcomas can arise. Herein, we report a case of a 55-year-old woman who was found to have disseminated endometriosis and low-grade endometrioid stromal sarcoma, with bowel and liver parenchymal metastasis, 7 years after undergoing supracervical hysterectomy with unconfined uterine morcellation for adenomyosis. Our case highlights the potential for malignant transformation of disseminated adenomyosis/endometriosis and the importance of patient counseling and shared decision-making prior to morcellation procedures.

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

Pepin

Cope

Einarsson

et al. 2021

Journal of Minimally Invasive Gynecology

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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.

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Single port access laparoscopic subtotal hysterectomy using contained manual morcellation: Experience from a tertiary referral center in Taiwan

Abstract: Single port access LSH using contained manual morcellation represents a safe and feasible alternative to conventional LSH using open power morcellation.

Cited by 5 publications

References 18 publications

The incidence of unexpected uterine malignancies in hysterectomies carried out for benign indications

The incidence of unexpected uterine malignancies in hysterectomies carried out for benign indications

Disseminated Endometriosis and Low-Grade Endometrioid Stromal Sarcoma in a Patient with a History of Uterine Morcellation for Adenomyosis

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

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