Power morcellation for women undergoing laparoscopic supracervical hysterectomy — safety of procedure and clinical experience from 426 cases

Abstract

Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. Material and methods:The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% -symptomatic uterine fibromas, 12.7% -abnormal uterine bleeding, 8.9% -suspicion of uterine adenomyosis) between January 2011 and December 2015. Premalignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. Results:The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. Conclusions:The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

Occult uterine malignancy during laparoscopic supracervical hysterectomy

“…The most frequent occult malignancy was EC, eg. previous Polish study showed the incidence of EC equal to 1:142 [27]. No EC was encountered in our cohort, however 3 cases of AH were confirmed postoperatively.…”

“…EC, are considered easy to detect. However, the incidence of undetected morcellated EC may be higher, as was shown in another Polish study [27]. These incidents are a mater of financial compensation to the victims, especially in United States.…”

“…A few other reports focused on LSH were published (Tab. 8) [19][20][21][22][23][24][25][26][27][28]. Some studies have focused only on the incidence of occult leiomyosarcoma, because other malignancies, eg.…”

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

“…All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. The study concluded that the incidence of unintended endometrial carcinoma in morcellated uteri after LASH was relatively small [14]. However, careful preoperative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation [14].…”

“…The aim of a recent study by Rechberger et al [14] was to evaluate the rate of unexpected malignancies among women who underwent laparoscopic supracervical hysterectomy (LASH) with power morcellation. The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4%-symptomatic uterine fibromas, 12.7%-abnormal uterine bleeding, 8.9%-suspicion of uterine adenomyosis) between January 2011 and December 2015.…”