Morcellation of the Uterus: Is There Any Place?
- PDF / 392,013 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 20 Downloads / 197 Views
GYNECOLOGIC CANCERS (NS REED, SECTION EDITOR)
Morcellation of the Uterus: Is There Any Place? Michael J. Halaska 1 & Myriam Gracia 2 & Rene Laky 3 & Ignacio Zapardiel 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper aims to review recent findings related to uterine morcellation. Recent Findings In 2014, the US Food and Drug Administration (FDA) issued a safety communication warning against the use of laparoscopic power morcellators. Summary A risk of occult uterine sarcoma in women is 1/770 to 1/10,000. Our goal is to minimize the risk of spillage due to morcellation and balance it with other risks due to different surgical approaches. In case of a presence of sarcoma risk factors, any form of morcellation should be contraindicated. Power morcellation should be limited to myomectomies. In peri- and postmenopausal age, an endometrial biopsy is highly recommended before surgery with expected morcellation. It is important to explain to the patient the risks of morcellation and the risks and benefits of different surgical approaches. Finally, women should be informed that the prognosis of leiomyosarcoma is poor regardless of the method of removal. Keywords Uterine sarcoma . Morcellation . Myomectomy . Containment bags . Laparoscopic hysterectomy . Oncological risk
Introduction Over the years, patients with a large uterus and huge fibroids have undergone open abdominal surgery. Gynecologists have been among the first to adopt laparoscopic surgery. Initially, physicians relied on manual morcellation through larger abdominal incisions or vaginally with basic surgical instruments [1]. In 1993, the development of electronic power morcellation systems allowed these patients to benefit from the advantages of minimally invasive surgery. These devices assisted surgeons in removing large pieces of tissue with higher efficiency than morcellation with a scalpel and large skin incisions. However, leiomyoma or uterus uncontained This article is part of the Topical Collection on Gynecologic Cancers * Michael J. Halaska [email protected] 1
Department of Obstetrics and Gynaecology, Faculty Hospital Kralovske Vinohrady and 3rd Medical Faculty, Charles University in Prague, Šrobárova 1150/50, Praha 10, 100 34 Prague, Czech Republic
2
Gynaecologic Oncology Unit, La Paz University Hospital – IdiPAZ, Madrid, Spain
3
Division of Gynaecology, Medical University of Graz, Graz, Austria
morcellation increases the risk of both benign and malignant cell dispersion within the peritoneal cavity [2].
Techniques of Morcellation &
&
Abdominal morcellation: the extraction of the tissue from the abdominal cavity can be performed laparoscopically or robotically with a power morcellator system, which consists of an electromechanical device introduced in the abdominal cavity through a trocar incision. Another possibility is to morcellate specimens through minilaparotomy, fragmenting the tissue with scissors or scalpel [3]. Vaginal morcellation: when laparoscopic hysterectomy is perfor
Data Loading...
