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Obstetrics and Gynecology Jan 2016To estimate the incidence of occult uterine sarcoma and leiomyosarcoma in hysterectomies for leiomyomas and the risk associated with their morcellation.
OBJECTIVE
To estimate the incidence of occult uterine sarcoma and leiomyosarcoma in hysterectomies for leiomyomas and the risk associated with their morcellation.
METHODS
We conducted a population-based cohort study. All uterine sarcomas from 2006-2013 in an integrated health care system were identified. Age- and race-specific incidences of occult uterine sarcoma were calculated. Kaplan-Meier survival analysis was performed. Crude and adjusted risk ratios of recurrence and death associated with morcellation at 1, 2, and 3 years were estimated using Poisson regression with inverse probability weighting.
RESULTS
There were 125 hysterectomies with occult uterine sarcomas identified among 34,728 hysterectomies performed for leiomyomas. The incidence of occult uterine sarcoma and leiomyosarcoma was 1 of 278 or 3.60 (95% confidence interval [CI] 2.97-4.23) and 1 of 429 or 2.33 (95% CI 1.83-2.84) per 1,000 hysterectomies. For stage I leiomyosarcoma (n=111), eight (7.2%) were power and 27 (24.3%) nonpower-morcellated. The unadjusted 3-year probability of disease-free survival for no morcellation, power and nonpower morcellation was 0.54, 0.19, and 0.51, respectively (P=.15); overall survival was 0.64, 0.75, and 0.68, respectively (P=.97). None of the adjusted risk ratios for recurrence or death were significant except for death at 1 year for power and nonpower morcellation groups combined (6/33) compared with no morcellation (4/76) (5.12, 95% CI 1.33-19.76, P=.02). We had inadequate power to infer differences for all other comparisons including 3-year survival and power morcellation.
CONCLUSION
Morcellation is associated with decreased early survival of women with occult leiomyosarcomas. We could not accurately assess associations between power morcellation and 3-year survival as a result of small numbers.
Topics: California; Colorado; Disease-Free Survival; Female; Humans; Hysterectomy; Incidence; Incidental Findings; Kaplan-Meier Estimate; Leiomyoma; Leiomyosarcoma; Middle Aged; Morcellation; Neoplasm Recurrence, Local; Neoplasms, Unknown Primary; Survival Rate; Uterine Myomectomy; Uterine Neoplasms
PubMed: 26646120
DOI: 10.1097/AOG.0000000000001187 -
Minimally Invasive Therapy & Allied... Mar 2022Despite the significant advantages of morcellation, it may be associated with severe complications. We aimed to determine both direct and indirect complication rates of...
INTRODUCTION
Despite the significant advantages of morcellation, it may be associated with severe complications. We aimed to determine both direct and indirect complication rates of morcellation at gynecological laparoscopy.
MATERIAL AND METHODS
This multicenter retrospective study included patients traced from 2008 to 2017. We identified women who underwent an operation with the use of electromechanical power morcellation (EMM) or vaginal manual morcellation during laparoscopy. Clinical records, intraoperative-postoperative outcomes were reviewed.
RESULTS
We analyzed 1795 patients who underwent laparoscopic supracervical hysterectomy (LASH), total hysterectomy (TLH), or myomectomy (45.5%, 14.2%, and 40.3%, respectively). No severe intraoperative complications associated with morcellation or parasitic leiomyoma were observed. Patients with unexpected sarcoma were detected in five cases (0.28%). Four of them were detected after LASH and one after vaginal manual morcellation following TLH, who had an intraabdominal recurrence and died after 18 months. The patients after LASH underwent secondary laparotomy for staging; no histological dissemination of sarcoma was observed, however two had a recurrence. The five-year survival rate was 80%.
CONCLUSIONS
There is a small risk of intraoperative complications or unexpected malignancy following morcellation, provided the surgeon adheres to regular surgical standards. In patients with a normal size uterus, TLH could be preferred over LASH to avoid morcellation.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Morcellation; Retrospective Studies; Uterine Myomectomy; Uterine Neoplasms
PubMed: 32762476
DOI: 10.1080/13645706.2020.1802292 -
Clinical Obstetrics and Gynecology Dec 2015Intracorporeal electromechanical morcellation has been available for nearly 2 decades, and has allowed hundreds of thousands of women to undergo hysterectomy and... (Review)
Review
Intracorporeal electromechanical morcellation has been available for nearly 2 decades, and has allowed hundreds of thousands of women to undergo hysterectomy and myomectomy in a minimally invasive approach. Despite gains in postoperative pain, complications, quality of life, hospital stay, and return to work, it has recently come under attack. The risk of inadvertent morcellation of a uterine malignancy, and subsequent dissemination of occult cancer, must be balanced by the risks of increased numbers of laparotomies. Power morcellation should be available to appropriate surgical candidates.
Topics: Female; Humans; Hysterectomy; Incidence; Informed Consent; Laparoscopy; Leiomyoma; Leiomyosarcoma; Morcellation; Neoplasm Seeding; Neoplasm Staging; Patient Selection; Risk Assessment; Risk Factors; Uterine Myomectomy; Uterine Neoplasms
PubMed: 26512438
DOI: 10.1097/GRF.0000000000000150 -
Medical Science Monitor : International... Jul 2022BACKGROUND Hysteroscopic surgery has been widely used in clinical practice for more than 30 years due to its advantages of less trauma, less bleeding, and direct vision.... (Meta-Analysis)
Meta-Analysis
BACKGROUND Hysteroscopic surgery has been widely used in clinical practice for more than 30 years due to its advantages of less trauma, less bleeding, and direct vision. The aim of this study was to compare hysteroscopic morcellation versus conventional resectoscopy for removal of endometrial lesions. MATERIAL AND METHODS For the database search, we used the keywords "morcellator," "morcellators," "morcellate," "morcellation," and "morcellated" combined with "hysteroscopy," "hysteroscopy," "uteroscope," and "transcervical". The last search was conducted on February 1, 2022. Randomized controlled trials (RCTs) were included in the meta-analysis. RESULTS According to our retrieval scheme and the inclusion and exclusion criteria, we found 6 studies including 565 patients. For enumeration data, we calculated the effect size as relative risk (RR) and 95% confidence interval (95% CI), while for quantitative data we used the weighted mean difference (WMD) and 95% confidence interval (95% CI). There was no significant difference between success rate of hysteroscopic morcellation and conventional resectoscopy (relative risk and 95% confidence interval 1.05(0.97,1.13); P=0.232). Procedure time was also shorter with hysteroscopic morcellation, the procedure time of the hysteroscopic morcellation group was 3.43 min shorter compared with the conventional resectoscopy group, and the operating time in the hysteroscopic morcellation group was 2.81 min shorter. In terms of fluid deficit, there was no statistically significant difference in fluid loss between the 2 groups (P=0.209). CONCLUSIONS Hysteroscopic morcellation is associated with a shorter procedure time and operative time among patients with endometrial lesions compared with resectoscopy.
Topics: Female; Humans; Hysteroscopy; Morcellation; Operative Time; Pregnancy
PubMed: 35844074
DOI: 10.12659/MSM.936771 -
Clinical Obstetrics and Gynecology Dec 2015Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more... (Review)
Review
Adverse events associated with hysteroscopic procedures are generally rare, but, with increasing operative complexity, it is now apparent that they are experienced more often. There exists a spectrum of complications that relate to generic components of procedures, such as patient positioning, anesthesia, and analgesia, to a number that are specific to intraluminal endoscopic surgery that largely comprise perforation and injuries to surrounding structures and blood vessels. Whereas a number of endoscopic procedures require the use of distending media, the response of premenopausal women to excessive absorption of nonionic fluids used for hysteroscopy is somewhat unique, and deserves special attention on the part the surgeon. There is also an increasing awareness of uncommon but problematic sequelae related to the use of monopolar radiofrequency uterine resectoscopes that involve thermal injury to the vulva and vagina. Furthermore, the uterus that has previously undergone hysteroscopic surgery may behave in unusual ways, at least in premenopausal women who experience menstruation or who become pregnant. Fortunately, better understanding of the mechanisms involved in these adverse events, as well as the use or development of a number of innovative devices, have collectively provided the opportunity to perform hysteroscopic and resectoscopic surgery in a manner that minimizes risk to the patient.
Topics: Anesthesia; Bacterial Infections; Blood Loss, Surgical; Cervix Uteri; Electrosurgery; Embolism, Air; Female; Humans; Hysteroscopy; Insufflation; Laparoscopy; Morcellation; Patient Positioning; Uterine Perforation
PubMed: 26457853
DOI: 10.1097/GRF.0000000000000146 -
Journal of Minimally Invasive Gynecology 2017To demonstrate a new technique to improve vaginal morcellation.
STUDY OBJECTIVE
To demonstrate a new technique to improve vaginal morcellation.
DESIGN
This video demonstrates a step-by-step process for morcellation through the vagina in a contained environment (Canadian Task Force Classification III).
SETTING
When performing laparoscopic hysterectomy, difficulty arises when the tissue being extracted is larger than the incision made. To avoid extending an abdominal incision, the colpotomy tends to be the favorable location for removal. The difficulty with vaginal morcellation lies in retraction and keeping the specimen at the colpotomy site.
INTERVENTION
This 42-year-old gravida 0 female with abnormal uterine bleeding with leiomyoma had completed child-bearing and desired a hysterectomy. She had a 17-week sized uterus with enlarged bulky myomas. Total laparoscopic hysterectomy was performed using three 5-mm ports. After the hysterectomy completed, the specimen was placed in a bag for removal. Morcellation was performed, and the specimen was removed. This video demonstrates a simple technique for containing the specimen using a bag, an Alexis ring, and a stapler, and then removing it vaginally. This approach provides vaginal protection and retraction in a contained system. It also eliminates the need to close the abdominal fascia.
CONCLUSION
Morcellation performed through the vagina can be quick and easy using the technique shown in this video. Not only does the technique provide vaginal protection and retraction, but it also contains the specimen to prevent its loss during the morcellation process and to avoid the spread of any unforeseen malignancy. By eliminating the need to close the abdominal fascia, surgical time is reduced, and concerns about hernia formation from extended incisions are allayed.
Topics: Adult; Colpotomy; Female; Humans; Hysterectomy; Laparoscopy; Leiomyoma; Morcellation; Operative Time; Pregnancy; Uterine Neoplasms; Vagina
PubMed: 28232039
DOI: 10.1016/j.jmig.2017.02.005 -
Complications in Laparoscopic Supracervical Hysterectomy(LASH), especially the morcellation related.Best Practice & Research. Clinical... Aug 2016Laparoscopic supracervical hysterectomy (LASH) is an alternative minimally invasive approach to total laparoscopic hysterectomy or laparoscopically assisted vaginal... (Review)
Review
Laparoscopic supracervical hysterectomy (LASH) is an alternative minimally invasive approach to total laparoscopic hysterectomy or laparoscopically assisted vaginal hysterectomy. It is a safe and effective treatment of bleeding disorders and dysmenorrhoea in uterine myomatosis and/or adenomyosis. LASH has a low rate of major and minor complications, and patient satisfaction is very high. In order to extract the transected tissue from the abdomen, one essential condition for LASH is the intra-abdominal disruption of the uterine tissue by transabdominal, transcervical or transvaginal morcellation. In the following, complications in LASH, especially those related to electronic power morcellation, are described evaluating the recent literature.
Topics: Contraindications; Female; Humans; Hysterectomy; Intestines; Intraoperative Complications; Laparoscopy; Morcellation; Neoplasm Seeding; Patient Satisfaction; Postoperative Complications; Urinary Tract; Uterine Neoplasms
PubMed: 26694587
DOI: 10.1016/j.bpobgyn.2015.11.001 -
Ginekologia Polska 2022Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction...
OBJECTIVES
Morcellation is an integral part of laparoscopic procedures related to uterine fibroids, which consist of the mechanical fragmentation of the tumor and its extraction outside the abdominal cavity. To avoid the risk of tissue dissemination, special extraction systems have been developed, which allow morcellation of the specimen under visual control and its removal without contact with the abdominal organs. The aim of the paper is to compare the two systems for laparoscopic morcellation.
MATERIAL AND METHODS
The study included 33 premenopausal women with symptomatic leiomyomas or adenomyosis, who were qualified for laparoscopic surgery with contained power morcellation. Patients were allocated alternately to a different tissue extraction system's group. According to the study protocol, selected operative parameters were prospectively recorded. Finally, an assessment of bag use was performed. The data was statistically analyzed.
RESULTS
There were significant differences between the two tested systems in terms of introducing and positioning the bag, its removal from the peritoneal cavity, as well as optic trocar insertion and establishing the pseudo-peritoneum.
CONCLUSIONS
Despite the minor design differences and some ergonomic aspects, both presented systems proved to be safe and feasible tools for laparoscopic contained morcellation. This technique both reduces the risk of tissue dissemination and preserves the advantages of minimal invasiveness.
Topics: Humans; Female; Uterine Neoplasms; Uterine Myomectomy; Morcellation; Leiomyoma; Laparoscopy; Hysterectomy; Peritoneum
PubMed: 35315008
DOI: 10.5603/GP.a2022.0001 -
Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment?AJR. American Journal of Roentgenology Dec 2018The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with... (Review)
Review
OBJECTIVE
The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with treating women with potential occult leiomyosarcomas (LMSs), and review the known and emerging imaging features of typical and atypical leiomyomas and explain how to differentiate them from LMSs.
CONCLUSION
Surgical management of presumed benign uterine leiomyomas received popular media attention when a case of disseminated LMS occurred after laparoscopic power morcellator-assisted hysterectomy. A subsequent U.S. Food and Drug Administration review found a higher prevalence of unsuspected uterine sarcoma and LMS among patients undergoing myomectomy or hysterectomy for presumed benign leiomyomas than was previously reported. This heightened concern has led to increased pressure on radiologists to distinguish LMSs from leiomyomas.
Topics: Diagnosis, Differential; Female; Humans; Hysterectomy; Leiomyoma; Leiomyosarcoma; Magnetic Resonance Imaging; Uterine Neoplasms
PubMed: 30354268
DOI: 10.2214/AJR.17.19234 -
Ceska Gynekologie 2022To summarize recent data and knowledge of laparoscopic power morcellation.
OBJECTIVE
To summarize recent data and knowledge of laparoscopic power morcellation.
METHODS
Review of articles.
RESULTS
Laparoscopic morcellation has been introduced to gynecologic surgery in 90s. In 2014, Food and Drug Administration announced negative statement about the morcellation use due to the risk of potential spreading of malignant tumor cells. This statement reduced utilization of morcellation, especially in the United States. Since that, many health institutions and organizations started new researches focused on the safety of this surgical technique. After a couple of years, the morcellation is considered as a useful tool if certain rules are followed.
CONCLUSION
Morcellation has a place in laparoscopic operative procedures even in 2022, in condition of correct selection of patients and possible utilization of contained in-bag morcellation.
Topics: Female; Humans; Hysterectomy; Laparoscopy; Leiomyoma; Morcellation; United States; Uterine Myomectomy; Uterine Neoplasms
PubMed: 36055791
DOI: 10.48095/cccg2022289