To Assess the Safety of Morcellation for Removing Uterine Specimen During Laparoscopic and Vaginal Hysterectomies for Leiomyomas.

IntroductionThe ability to offer less invasive surgery for leiomyomas to women often requires the removal of large tissue specimens through small incisions, which is facilitated by morcellation. Electromechanical morcellation may lead to dissemination of occult uterine malignancy throughout the intraperitoneal cavity and may worsen the prognosis.ObjectivesTo assess the safety of morcellation for removing uterine specimen during laparoscopic and vaginal hysterectomies for leiomyoma and to find incidence of leiomyosarcoma (LMS) in morcellated specimens.Materials and methodsThis study was a retrospective case series done at Aarogya Hospital and Test Tube Baby Centre, Raipur, from January 1, 2011 to November 30, 2015. Total 232 cases were analyzed to assess the safety of vaginal and laparoscopic morcellation technique. All histopathological reports were analyzed to find incidence of LMS in morcellated specimen.ResultsIn the study period 55.55 % hysterectomies were performed for fibroid uterus. All patients were multiparous and 82.75 % had not attained menopause. Preoperative cervical cytology and endometrial biopsy reports were not suggestive of malignancy in any case. Histopathology reports of all the morcellated specimens were consistent with leiomyoma.ConclusionThe risk of occult LMS is extremely low, especially in reproductive age group women. We believe that more studies and guidelines are required for Indian women.