Unanticipated Uterine Pathologic Finding After Morcellation During Robotic-Assisted Supracervical Hysterectomy and Cervicosacropexy for Uterine Prolapse

Hill, Audra Jolyn; Carroll, Ashley; Matthews, Catherine A.

doi:10.1097/spv.0b013e31829ff5b8

Cited by 34 publications

(16 citation statements)

References 18 publications

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“…Others have reported a rate of 0.3-15% of endometrial cancer in patients undergoing hysterectomy for benign conditions [7]. Most recently, Hill et al [8] found a 3% rate of endometrial cancer among 63 women who underwent uterine morcellation as part of surgical management of prolapse. The rate was much lower in a study evaluating 708 women undergoing hysterectomy for pelvic organ prolapse, in which the incidence of endometrial cancer was only 0.6% [9].…”

Section: Discussionmentioning

confidence: 97%

Incidental power morcellation of malignancy: A retrospective cohort study

Graebe¹,

Garcia-Soto²,

Aziz³

et al. 2015

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 97%

Incidental power morcellation of malignancy: A retrospective cohort study

Graebe¹,

Garcia-Soto²,

Aziz³

et al. 2015

Gynecologic Oncology

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“…Cerivical cancer is almost always a known preoperative diagnosis, and the risk of tissue dissemination appears to be less serious with endometrial cancer. 16 Ten sources were considered regarding the incidence of leiomyosarcoma among women undergoing hysterectomy for presumed fibroids (Table 2). 4, 17-25 Quality and the degree to which the study population mirrored that for our decision analysis was evaluated based on year of publication, menopausal status, number of subjects, geographical location, and pathologic criteria used to determine leiomosarcoma diagnosis.…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroid tumors in premenopausal women: a decision analysis

Siedhoff

Wheeler

Rutstein

et al. 2015

American Journal of Obstetrics and Gynecology

100

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Objective To model outcomes in laparoscopic hysterectomy with morcellation compared to abdominal hysterectomy for the presumed fibroid uterus, examining short-and long-term complications, as well as mortality. Study Design A decision tree was constructed to compare outcomes for a hypothetical cohort of 100,000 premenopausal women undergoing hysterectomy for presumed fibroids over a 5-year time horizon. Parameter and quality of life utility estimates were determined from published literature for postoperative complications, leiomyosarcoma incidence, death related to leiomyomsarcoma, and procedure-related death. Results The decision analysis predicted fewer overall deaths with laparoscopic hysterectomy compared to abdominal hysterectomy (98 vs. 103 per 100,000). While there were more deaths from leiomyosarcoma following laparoscopic hysterectomy (86 vs. 71 per 100,000), there were more hysterectomy-related deaths with abdominal hysterectomy (32 vs. 12 per 100,000). The laparoscopic group had lower rates of transfusion (2,400 vs. 4,700 per 100,000), wound infection (1,500 vs 6,300 per 100,000), venous thromboembolism (690 vs. 840 per 100,000) and incisional hernia (710 vs. 8,800 per 100,000), but a higher rate of vaginal cuff dehiscence (640 vs. 290 per 100,000). Laparoscopic hysterectomy resulted in more quality-adjusted life years (499,171 vs. 490,711 over five years). Conclusion The risk of leiomyosarcoma morcellation is balanced by procedure-related complications associated with laparotomy, including death. This analysis provides patients and surgeons with estimates of risk and benefit, upon which patient-centered decisions can be made.

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“…2 Only one other published series focused exclusively on prolapse patients who received supracervical hysterectomy, morcellation, and sacrocolpopexy. In that study, Hill et al 13 reported an occult malignancy rate of 3.2% among just 63 cases. They note that all diagnosed patients were asymptomatic and hence did not receive preoperative endometrial evaluation.…”

Section: Discussionmentioning

confidence: 96%

Prevalence of Occult Malignancy Within Morcellated Specimens Removed During Laparoscopic Sacrocolpopexy

Vallabh-Patel

Saiz

Salamon

et al. 2016

Female Pelvic Med Reconstr Surg

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Unanticipated Uterine Pathologic Finding After Morcellation During Robotic-Assisted Supracervical Hysterectomy and Cervicosacropexy for Uterine Prolapse

Abstract: Owing to the risk of occult uterine pathologic finding and complicated postoperative management, preoperative endometrial assessment should be considered on all postmenopausal patients undergoing intra-abdominal uterine morcellation, regardless of risk factors.

Cited by 34 publications

References 18 publications

Incidental power morcellation of malignancy: A retrospective cohort study

Incidental power morcellation of malignancy: A retrospective cohort study

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroid tumors in premenopausal women: a decision analysis

Prevalence of Occult Malignancy Within Morcellated Specimens Removed During Laparoscopic Sacrocolpopexy

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