Power morcellation for women undergoing laparoscopic supracervical hysterectomy - safety of procedure and clinical experience from 426 cases

Tomasz Rechberger, Paweł Miotła, Konrad Futyma, Alicja Ziętek, Aleksandra Filipczak, Ewa Rechberger, Justyna Szumiło, Aneta Adamiak-Godlewska
Ginekologia polska · 2016 · doi:10.5603/GP.2016.0042 · PMID:27629127
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This study analyzed 426 laparoscopic supracervical hysterectomies with power morcellation and found an unexpected malignancy rate of 0.9%, primarily endometrial carcinomas.

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This retrospective study analyzed clinical data from 426 consecutive women who underwent laparoscopic supracervical hysterectomy with power morcellation for presumed benign indications between 2011 and 2015, including symptomatic uterine fibromas, abnormal uterine bleeding, and suspicion of uterine adenomyosis, while excluding cases with premalignant or malignant preoperative findings in the cervix and uterine corpus. Unexpected malignancies were identified in 4 patients (0.9%), consisting of one ovarian cancer and three endometrial carcinomas, and all required abdominal reoperations; histology of the removed cervix and adnexa showed no abnormalities. The authors conclude that unintended endometrial carcinoma incidence after morcellation was relatively small, with a stated caveat emphasizing careful preoperative counseling to rule out malignancy. Relevance to endometriosis and adenomyosis: the cohort included women with suspicion of uterine adenomyosis (8.9%), making it directly relevant to adenomyosis while evaluating cancer safety after power morcellation in a broader gynecologic context.

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Abstract

OBJECTIVES: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation. MATERIAL AND METHODS: The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% - symptomatic uterine fibromas, 12.7% - abnormal uterine bleeding, 8.9% - suspicion of uterine adenomyosis) between January 2011 and December 2015. Pre-malignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH. RESULTS: The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa. CONCLUSIONS: The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.
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Abstract

Objectives: Minimally invasive gynaecological surgeries are performed for several malignant and nonmalignant indications. The aim of our study was to evaluate the rate of unexpected malignancies among women who underwent laparoscopical supracervical hysterectomy (LASH) with power morcellation.

Material and methods

The retrospective analysis included clinical data of 426 consecutive female patients who underwent LASH with power morcellation due to presumed benign disorders (78.4% — symptomatic uterine fibromas, 12.7% — abnormal uterine bleeding, 8.9% — suspicion of uterine adenomyosis) between January 2011 and December 2015. Premalignant or malignant preoperative abnormalities in the cervix and the uterine corpus were contraindications for LASH.

Results

The unexpected malignancies were found in four patients from study group: one ovarian cancer located on the inner part of simple ovarian cyst and 3 endometrial carcinomas (0.9%) were documented. All these patients underwent abdominal reoperations and no histological abnormalities were detected in the extirpated cervix and adnexa.

Conclusions

The incidence of unintended endometrial carcinoma in morcellated uterus after LASH was relatively small. However, careful pre-operative counseling should be undertaken in order to exclude the possibility of any malignant disease in uteri among women scheduled to power morcellation.

Keywords

laparoscopic assisted supracervical hysterectomypower morcellationmyomaminimally invasive gynecological surgeries

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Hysterectomy Laparoscopy Leiomyoma Morcellation Uterine Hemorrhage Uterine Neoplasms Adenomyosis Female Humans Hysterectomy Hysterectomy Laparoscopy Laparoscopy Leiomyoma Morcellation Morcellation Ovarian Neoplasms Ovarian Neoplasms Postoperative Complications

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