Regarding “Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy with Morcellation”

Wilde, Rudy Leon De

doi:10.1016/j.jmig.2017.07.024

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…Regarding sarcoma prognosis, tumor injury during excision and uncontained morcellation, electric or manual, in both laparotomy and laparoscopy [30][31][32], plays a critical role in upgrading metastasis, resulting in poorer prognosis [33][34][35][36][37]. Hence, several prognostic factors for all histological uterine sarcoma types have been identified, including patient age, tumor stage, mitotic index, vascular invasion, and tumor-free resection margins.…”

Section: Discussionmentioning

confidence: 99%

The Future of Minimal-Access Myoma Surgery with In-Bag Contained Morcellation

Devassy

Wilde

et al. 2023

JCM

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Contained electromechanical morcellation has emerged as a safety approach for laparoscopic myomatous tissue retrieval. This retrospective single-center analysis evaluated the bag deployment practicability and safety of electromechanical in-bag morcellation when used for big surgical benign specimens. The main age of patients was 39.3 years (range 21 to 71); 804 myomectomies, 242 supracervical hysterectomies, 73 total hysterectomies, and 1 retroperitoneal tumor extirpation were performed. A total of 78.7% of specimens weighed more than 250 g (n = 881) and 9% more than 1000 g. The largest specimens, weighing 2933 g, 3183 g, and 4780 g, required two bags for complete morcellation. Neither difficulties nor complications related to bag manipulation were recorded. Small bag puncture was detected in two cases, but peritoneal washing cytology was free of debris. One retroperitoneal angioleiomyomatosis and three malignancies were detected in histology (leiomyosarcoma = 2; sarcoma = 1); therefore, patients underwent radical surgery. All patients were disease-free at 3 years follow-up, but one patient presented multiple abdominal metastases of the leiomyosarcoma in the third year; she refused subsequent surgery and was lost from follow-up. This large series demonstrates that laparoscopic bag morcellation is a safe and comfortable method to remove large and giant uterine tumors. Bag manipulation takes only a few minutes, and perforations rarely occur and are easy to detect intraoperatively. This technique did not result in the spread of debris during myoma surgery, potentially avoiding the additional risk of parasitic fibroma or peritoneal sarcoma.

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