-
Current Treatment Options in Oncology Feb 2018Uterine leiomyosarcoma (uLMS) is a rare disease; in the data from the SEER database, 3165 cases of uLMS were diagnosed between January 2000 and December 2012. While a... (Review)
Review
Uterine leiomyosarcoma (uLMS) is a rare disease; in the data from the SEER database, 3165 cases of uLMS were diagnosed between January 2000 and December 2012. While a majority of patients (60%) are diagnosed with early stage disease, recurrence rates are high. Five-year disease-specific survival is 76% for patients with FIGO stage I and 60% for patients with FIGO stage II disease. Adjuvant treatments, including radiation therapy, chemotherapy, and combined modality approaches, have been explored with the goal of demonstrating improved survival. However, heterogeneous patient populations, small sample sizes, and lack of no-treatment control arms have limited the interpretation and reliability of the results from these studies. A randomized trial of adjuvant pelvic radiation compared to no additional treatment showed that adjuvant radiation did not improve recurrence or survival outcomes for early-stage uterine LMS. To date, no prospective, randomized trial has been completed comparing adjuvant chemotherapy to observation. A recent well-designed retrospective study showed that women treated with adjuvant gemcitabine-docetaxel had no improvement in progression-free or overall survival compared to women who received no additional treatment. Thus, current data support our recommendation against adjuvant radiation or chemotherapy treatment for patients with non-morcellated, completely resected, and uterine-confined leiomyosarcoma. We recommend that these patients be observed with periodic surveillance imaging and physical examinations.
Topics: Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Female; Humans; Leiomyosarcoma; Morcellation; Neoplasm Recurrence, Local; Radiotherapy, Adjuvant; Uterine Neoplasms
PubMed: 29417238
DOI: 10.1007/s11864-018-0526-0 -
Journal of Minimally Invasive Gynecology 2015To evaluate adverse events associated with electromechanical morcellation as reported to the Manufacturer and User Facility Device Experience (MAUDE) database. (Review)
Review
STUDY OBJECTIVE
To evaluate adverse events associated with electromechanical morcellation as reported to the Manufacturer and User Facility Device Experience (MAUDE) database.
DESIGN
Retrospective analysis of an established database (Canadian Task Force classification III).
INTERVENTION
A search of the MAUDE database for terms associated with commercially available electromechanical morcellation devices was undertaken for events leading to injury or death between 2004 and 2014. Data, including the types of injury, need for conversion to open surgery, type of open surgery, and clinical outcomes, were extracted from the records.
MEASUREMENTS AND MAIN RESULTS
Over a 10-year period, 9 events associated with death and 215 events associated with patient injury or significant delay of the surgical procedure were recorded. These involved 137 device failures, 51 organ injuries, and the morcellation of 27 previously undiagnosed malignancies. Of the 9 deaths, 1 was associated with organ injury, and the other 8 were associated with morcellation of cancer. Of the 27 undiagnosed cancers, 5 were reported by the manufacturer, 8 were reported by the patient or family, 9 were reported by medical or news reports, 2 were reported by medical professionals, and 3 were due to litigation. Morcellation of an undiagnosed malignancy was first reported to the database in December 2013.
CONCLUSIONS
The MAUDE database appears to detect perioperative events, such as device failures and organ injury at the time of surgery, but appears to be poor at detecting late events after surgery, such as the potential spread of cancer. Outcome registries are likely a more efficient means of tracking potential long-term adverse events associated with surgical devices.
Topics: Databases, Factual; Electrocoagulation; Equipment Design; Equipment Failure; Evidence-Based Medicine; Female; Humans; Morcellation; Retrospective Studies; Treatment Outcome
PubMed: 25987522
DOI: 10.1016/j.jmig.2015.05.008 -
Ginekologia Polska 2022Open power morcellation during a laparoscopic myomectomy (LM) can result in the dissemination of benign or occult malignant tumor cells in the abdominopelvic cavity. The...
OBJECTIVES
Open power morcellation during a laparoscopic myomectomy (LM) can result in the dissemination of benign or occult malignant tumor cells in the abdominopelvic cavity. The development of a new contained collection bag for power morcellation is now favored by gynecologic surgeons worldwide.
MATERIAL AND METHODS
This study was a single-arm trial comprising 20 women who consecutively underwent an LM involving the use of a newly designed contained collection bag for power morcellation between November 3rd 2017 and April 31st 2018. There was also a historical control group consisting of 30 women who underwent open power morcellation during an LM between May 1st 2017 and October 31st 2017. All the essential information concerning the patients and surgically related data, including the myoma size, the operation duration, and the cell count of the intraperitoneal irrigating fluid, were collected and analyzed.
RESULTS
The uterus size and the maximum diameters of the uterus and the myoma of the two groups were not significantly different (p = 0.65, p = 0.71, and p = 0.31, respectively). Pseudopneumoperitoneum was established and clear visualization was guaranteed in all 20 cases in the experimental group. The remaining fragment tissue amount (mean ± SD) and weight (mean ± SD) in the collection bag after morcellation in the experimental group were 5.00 ± 1.48 and 3.87 ± 1.31 (g). All the collection bags were routinely examined after the LM using normal saline, and no leaks or lesions were found. The cell counts of the intraperitoneal irrigating fluid both before and after morcellation were less than 105-106/L. The pathology of all the tissues confirmed that there were no malignant tumors. The operation of the experimental group was 18 mins longer than that of the historical control group (p = 0.00).
CONCLUSIONS
This newly designed collection bag system for LM morcellation is effective, feasible, and safe.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Leiomyoma; Morcellation; Myoma; Saline Solution; Uterine Myomectomy; Uterine Neoplasms
PubMed: 35315012
DOI: 10.5603/GP.a2022.0002 -
European Journal of Obstetrics,... Mar 2024This study aimed to comprehensively evaluate the complications associated with morcellation in Total Laparoscopic Hysterectomy (TLH) procedures, providing evidence-based... (Review)
Review
OBJECTIVE
This study aimed to comprehensively evaluate the complications associated with morcellation in Total Laparoscopic Hysterectomy (TLH) procedures, providing evidence-based insights to enhance patient safety and surgical efficacy.
DATA SOURCES
A comprehensive literature search was conducted using multiple databases, including PubMed, EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials. The inclusion criteria were Studies that focused on morcellation and morcellation-related complications were included. The risk of bias in the included studies was assessed using established evaluation scales.
METHODS OF STUDY SELECTION
Thirteen studies investigating complications associated with morcellation in TLH (Total Laparoscopic Hysterectomy) were included in this review.This review covers intraoperative blood loss, length of hospital stay, loss of bag integrity, mean uterine specimen and weight, morcellation time, operation time, and TLH morcellation complications.
TABULATION, INTEGRATION, AND RESULTS
The selected studies covered different approaches and aspects related to this procedure, providing valuable insights into the factors associated with complications and efficacy of the technique in various clinical settings.This review highlights the importance of evaluating and considering complications associated with morcellation in TLH.
CONCLUSION
The findings of this review provide valuable insights into complications associated with morcellation in TLH. Clinicians could use this information to make informed decisions, implement safe protocols, and improve patient care. Addressing these complications will enhance the safety and efficacy of morcellation for TLH. Ethical Compliance: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Topics: Female; Humans; Morcellation; Laparoscopy; Hysterectomy; Uterus; Uterine Myomectomy; Uterine Neoplasms
PubMed: 38301502
DOI: 10.1016/j.ejogrb.2024.01.031 -
BJOG : An International Journal of... Jan 2016Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of... (Review)
Review
BACKGROUND
Laparoscopic morcellation is frequently used for tissue removal after laparoscopic hysterectomy or myomectomy and may result in parasitic myomas, due to seeding of remained tissue fragments in the abdominal cavity. However, little is known about the incidence and risk factors of this phenomenon.
OBJECTIVES
To identify the incidence and risk factors for the development of parasitic myoma after laparoscopic morcellation.
SEARCH STRATEGY
A systematic review of the literature in Pubmed (MEDLINE) and Embase was conducted. Reference lists of identified relevant articles were checked for missing case reports.
SELECTION CRITERIA
Studies reporting on incidence or cases of parasitic myoma diagnosed after laparoscopic morcellation were selected. Studies were excluded when history of laparoscopic morcellation was lacking or final pathology demonstrated a malignancy or endometriosis.
DATA COLLECTION AND ANALYSIS
Data were extracted and analysed on incidence of parasitic myomas and characteristics of case reports.
MAIN RESULTS
Fourty-four studies were included. Sixty-nine women diagnosed with parasitic myomas after laparoscopic morcellation were identified. Mean age was 40.8 (± 7.5) years (range 24-57), median time between surgery and diagnosis was 48.0 months (range 1-192) and mean number of parasitic myomas was 2.9 (± 3.3) (range 1-16). The overall incidence of parasitic myomas after laparoscopic morcellation was 0.12-0.95%.
CONCLUSION
Although the incidence is relatively low, it is important to discuss the risk of parasitic myoma after laparoscopic morcellation with women and balance towards alternative treatment options. The duration of steroid exposure after laparoscopic morcellation might be a risk factor for development of parasitic myomas.
TWEETABLE ABSTRACT
Systematic review on the incidence and risk factors for parasitic myoma after laparoscopic morcellation.
Topics: Female; Humans; Hysterectomy; Iatrogenic Disease; Laparoscopy; Leiomyoma; Morcellation; Neoplasm Seeding; Risk Factors; Uterine Myomectomy; Uterine Neoplasms
PubMed: 26234998
DOI: 10.1111/1471-0528.13541 -
International Journal of Urology :... Mar 2018There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser... (Comparative Study)
Comparative Study Review
There are several options for the surgical management of benign prostatic hyperplasia representatively from transurethral resection of the prostate. Holmium laser enucleation of the prostate is one of those options, and many institutions and urologists have initiated this technique, and most of them have accomplished better outcomes compared with transurethral resection of the prostate. In contrast to transurethral resection of the prostate, which requires a similar procedure to transurethral resection of bladder tumors, holmium laser enucleation of the prostate requires a special surgical technique: enucleation and morcellation with around 10 years' history of experience, even in Japan. The present review introduces the current status of holmium laser enucleation of the prostate, so that it surely contributes to the knowledge of International Journal of Urology readers who could be experienced surgeons or beginners as well.
Topics: Adenoma; Humans; Laser Therapy; Lasers, Solid-State; Male; Morcellation; Prostatectomy; Prostatic Hyperplasia; Prostatic Neoplasms
PubMed: 29205507
DOI: 10.1111/iju.13507 -
Journal of Minimally Invasive Gynecology 2019Laparoscopic myomectomy has the advantages of a minimally invasive approach for the surgical treatment of myomas. The standardization and description of the technique...
STUDY OBJECTIVE
Laparoscopic myomectomy has the advantages of a minimally invasive approach for the surgical treatment of myomas. The standardization and description of the technique are the main objectives of this video. We described laparoscopic myomectomy in 10 steps, which could help make this procedure easier and safer [1].
SETTING
A French university tertiary care hospital.
PATIENTS
Patients with indication for laparoscopic myomectomy. The local institutional review board ruled that approval was not required for this video article because the video describes a technique and does not report a clinical case.
INTERVENTION
Standardized laparoscopic myomectomies were recorded to realize the video.
MEASUREMENTS AND MAIN RESULTS
This video presents a systematic approach to myomectomy clearly divided into 10 steps: (1) prepare your surgery, make selection and prehabilitation of patient [2], provide a good cartography of the myoma(s), and plan the surgery [3,4]; (2) ergonomy and material; (3) preventive hemostasis: triple occlusion; (4) hysterotomy; (5) enucleation by fast dissection and traction; (6) bipolar hemostasis; (7) check for missing myomas; (8) suture; (9) extraction/morcellation; and (10) prevent adhesions [5].
CONCLUSION
Standardization of laparoscopic myomectomy could make this procedure easier and safer to perform. The 10 steps presented help to perform each part of surgery in logical sequence making the procedure ergonomic and easier to adopt and learn. Standardization of laparoscopic techniques could help to reduce the learning curve.
Topics: Dissection; Female; France; Humans; Laparoscopy; Leiomyoma; Morcellation; Plastic Surgery Procedures; Uterine Myomectomy; Uterine Neoplasms
PubMed: 30639723
DOI: 10.1016/j.jmig.2018.12.021 -
Journal of Obstetrics and Gynaecology... Aug 2023Our objective was to identify predictors of morcellation during a total laparoscopic hysterectomy (TLH).
OBJECTIVES
Our objective was to identify predictors of morcellation during a total laparoscopic hysterectomy (TLH).
METHODS
A retrospective cohort study (Canadian Task Force classification II-2) taking place in a university hospital center in Quebec, Canada. Participants were women undergoing a TLH for a benign gynaecologic pathology from January 1, 2017, to January 31, 2019. All women underwent a TLH. If the uterus was too voluminous to be removed vaginally, surgeons favoured in-bag morcellation by laparoscopy. Uterine weight and characteristics were assessed before surgery by ultrasound or magnetic resonance imaging to predict morcellation.
RESULTS
A total of 252 women underwent a TLH and the mean age was 46 ± 7 (30-71) years old. The main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17-1572) ± 272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least 1 leiomyoma. Among women with a uterine weight <250 grams, 120 (95%) did not require morcellation. On the opposite, among women with a uterine weight >500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥250 vs. <250 grams; OR 3.7 [CI 1.8 to 7.7, P < 0.01]), having ≥ 1 leiomyoma (OR 4.1, CI 1.0 to 16.0, P = 0.01) and leiomyoma of ≥5 cm (OR 8.6, CI 4.1 to 17.9, P < 0.01) were other significant predictors morcellation in multivariate logistic regression analysis.
CONCLUSIONS
Uterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.
Topics: Female; Humans; Adult; Middle Aged; Aged; Male; Cohort Studies; Morcellation; Uterine Neoplasms; Retrospective Studies; Hysterectomy; Leiomyoma; Laparoscopy
PubMed: 37211086
DOI: 10.1016/j.jogc.2023.05.016 -
Journal of Minimally Invasive Gynecology 2019To identify the incidence of repeat surgery and subsequent findings after the performance of unconfined uterine power morcellation.
STUDY OBJECTIVE
To identify the incidence of repeat surgery and subsequent findings after the performance of unconfined uterine power morcellation.
DESIGN
A retrospective descriptive study (Canadian Task Force classification II-2).
SETTING
Southern California Kaiser Permanente Medical Centers.
PATIENTS
Women (N = 5154) who underwent laparoscopic supracervical hysterectomy with unconfined power morcellation.
MEASUREMENTS AND MAIN RESULTS
Of the 5154 cases, 279 (5.41%) underwent subsequent reoperation with a median of 24 months after index surgery. The most common clinical complaint leading to laparoscopic supracervical hysterectomy was symptomatic leiomyoma (n = 135, 48.4%) and abnormal uterine bleeding (n = 94, 33.7%). The most common indication for reoperation was a symptomatic adnexal mass (n = 87, 31.2%) followed by pelvic pain (n = 83, 29.7%). The majority (n = 128, 60.4%) of subsequent non-urogynecologic-related reoperations resulted in benign pathology. Endometriosis was the primary pathologic diagnosis in 65 of 279 (23.3%) of the reoperative cases; this was not previously documented in 86% (n = 57/65) of these cases. The overall frequency of subsequent pathology was endometriosis (65/5154, 1.26%), disseminated leiomyomatosis (18/5154, 0.35%), and new malignancy (11/5154, 0.21%).
CONCLUSION
Morcellation of nonmalignant tissue is not without consequence. Pathology confirmed endometriosis was documented for the first time in 20.4% of patients who underwent a second surgery. This finding raises the suspicion that morcellation and dispersion of the uterine specimen may be associated in the development of endometriosis.
Topics: Adult; California; Endometriosis; Female; Humans; Hysterectomy; Incidence; Laparoscopy; Leiomyomatosis; Middle Aged; Morcellation; Neoplasm Recurrence, Local; Peritoneal Diseases; Postoperative Complications; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Uterine Hemorrhage; Uterine Neoplasms
PubMed: 29783003
DOI: 10.1016/j.jmig.2018.05.010 -
Gynecologic Oncology Apr 2017Leiomyosarcoma, a rare tumor subtype, accounts for 1% of all uterine malignancies, but contributes to a significant proportion of uterine cancer deaths. Surgery is... (Review)
Review
Leiomyosarcoma, a rare tumor subtype, accounts for 1% of all uterine malignancies, but contributes to a significant proportion of uterine cancer deaths. Surgery is considered the mainstay of treatment for all soft tissue sarcomas, including uterine variants. However, uterine leiomyosarcoma is challenging to diagnose preoperatively and can mimic the appearance of benign uterine leiomyomas. Recently, concerns have grown in this regard, as surgeons have utilized uterine morcellation and myomectomy procedures unknowingly in the setting of occult uterine sarcoma. Because of aggressive tumor biology and relative chemotherapy and radiotherapy resistance, efficacious therapies to achieve prolonged survival or cure in those with both early and advanced-stage uterine leiomyosarcoma have been elusive. The strongest determinant of survival remains stage at diagnosis, though prediction models may provide a more accurate prognosis. Given the aggressive nature of this sarcoma subtype, novel early detection strategies and targeted therapies are the focus of several recently published and ongoing studies. While gemcitabine/docetaxel and doxorubicin remain the most active regimens in the treatment of advanced or recurrent disease, currently available cytotoxic regimens remain inadequate, with 5-year disease-specific survival of <30%. Pazopanib, trabectedin and olaratumab, are FDA-approved, targeted therapies with activity in uterine and other leiomyosarcomas, while aromatase inhibitors and immunotherapies are under active investigation. This review provides a critical appraisal of the literature regarding the contemporary surgical and medical management of uterine leiomyosarcoma, the role of targeted therapies, and the implications of uterine morcellation on gynecologic surgical practice.
Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal; Antineoplastic Combined Chemotherapy Protocols; Aromatase Inhibitors; Chemotherapy, Adjuvant; Deoxycytidine; Diagnostic Errors; Dioxoles; Docetaxel; Doxorubicin; Female; Humans; Hysterectomy; Indazoles; Laparoscopy; Leiomyoma; Leiomyosarcoma; Morcellation; Neoplasm Staging; Pyrimidines; Sulfonamides; Taxoids; Tetrahydroisoquinolines; Trabectedin; Uterine Myomectomy; Uterine Neoplasms; Gemcitabine
PubMed: 28209496
DOI: 10.1016/j.ygyno.2017.02.019