Safety and feasibility of contained uterine morcellation in women undergoing laparoscopic hysterectomy

Abstract

BackgroundWidespread concerns have been raised regarding the safety of power morcellation of uterine specimens because of the potential to disseminate occult malignancy. We sought to assess the safety and feasibility of contained manual uterine morcellation within a plastic specimen bag among women with uterine neoplasms.MethodsA retrospective single-institution descriptive cohort study was conducted from 2003 to 2014. Patients with leiomyoma and/or uterine malignancy who underwent minimally invasive surgery with contained uterine manual morcellation were identified from surgical logs. Demographic data, pathology results, operative details and adjuvant treatments were abstracted.ResultsEighty-eight patients were identified; 35 with leiomyoma and 53 with endometrial cancer. The mean age was 48 and 60, respectively. Uterine size/weight was greater in women with leiomyoma compared to those with cancer (15.1 weeks/448 g vs. 10.7 weeks/322 g). Mean operative time was 206 min (range 115–391) for leiomyoma cases and 238 min (range 131–399) for cancer cases. Median length of stay was 1 day (range 0–3 days). There were no cases of occult leiomyosarcoma and all specimens were successfully manually morcellated within a bag. There were no intraoperative complications. Thirty-day postoperative complications occurred in 7 patients, including one readmission for grade (G) 1 vaginal cuff separation after intercourse, G1 port-site hematoma (1), G2 port-site cellulitis (1), G2 vaginal cuff cellulitis (2), G2 bladder infection (2), G2 pulmonary edema (1), and G1 musculoskeletal injury (1).ConclusionsContained uterine hand morcellation is a feasible procedure with low peri-operative complication rates that allows for minimally invasive surgical procedures for women with large uterine neoplasms. Further evaluation is needed to assess survival outcomes for uterine malignancies.

Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review

“…Pathologic evaluation of morcellated uteri is more challenging, and there is a possibility that smaller uterine tumours would be missed. Furthermore, the complexity of this technique may require more advanced training to ensure safety in the hands of novice users [58]. In the review titled “Contained Morcellation: Review of Current Methods and Future Directions”, the authors concluded that there is currently no available method for tissue extraction that completely eliminates the risk of cellular dissemination [59].…”

Laparoscopic specimen retrieval bags in gyn surgery: Expert guidance on selection

“…[9][10][11] After the specimen is placed inside the containment system (typically a specimen bag), the surgeon may deliver the bag through a vaginal colpotomy or through a slightly extended laparoscopic incision to remove bulky specimens using cold-cutting extraction techniques. [12][13][14][15] Know the pathology's characteristics…”

Complete Laparoscopic Removal and Staging of a Large Ovarian Malignancy: A Case Report

“…Morcellation is a technique utilized in minimally invasive procedures, in which tissue specimens are broken up into smaller pieces using electromechanical power or hand mechanical power so that the specimen can be removed via an incision that is smaller than the original specimen size. Although this can address the problem of removing large specimens, there is some controversy with this technique, specifically in performing power morcellation during laparoscopic surgery, because of the potential to spread cancerous tissue within the abdominal and pelvic area in patients with unsuspected malignancy [ 7 , 8 ]. Concern for disseminated malignant cells became especially apparent after a patient with presumed leiomyoma was found to have leiomyosarcoma that had disseminated throughout the abdomen due to the use of a power morcellator [ 8 , 9 ].…”

“…Although this can address the problem of removing large specimens, there is some controversy with this technique, specifically in performing power morcellation during laparoscopic surgery, because of the potential to spread cancerous tissue within the abdominal and pelvic area in patients with unsuspected malignancy [ 7 , 8 ]. Concern for disseminated malignant cells became especially apparent after a patient with presumed leiomyoma was found to have leiomyosarcoma that had disseminated throughout the abdomen due to the use of a power morcellator [ 8 , 9 ]. This prompted the United States Food and Drug Administration (FDA) to address these concerns through the release of a warning communication in 2014 containing new guidelines and contraindications for morcellation procedures, which has discouraged power morcellation in minimally invasive gynecological surgery [ 9 ].…”