Laparoscopic supracervical hysterectomy with morcellation: should it stay or should it go?

To establish the risk of unidentified neoplasia and subsequent adverse outcomes of laparoscopic supracervical hysterectomy (SCH) with morcellation.

Retrospective review (Canadian Task Force classification II-2).

University community hospital.

Consecutive women who had undergone SCH with morcellation between January 2002 and December 2008.

Medical records were assessed for patient characteristics and outcomes. We identified 808 women who had undergone planned laparoscopic SCH with morcellation. Their median age was 44.1 years (range, 23.4-79.8 years). The most common indications were menorrhagia in 472 patients (58.4%) and leiomyomas in 400 patients (49.5%). Of the 30 patients in whom laparoscopy was converted to an open procedure before morcellation, 1 had leiomyosarcoma at final pathologic analysis. Of the 778 patients who underwent laparoscopic SCH with morcellation, 16 (2.0%) had endometrial hyperplasia and 3 (0.4%) had cancer at final pathologic analysis. Abnormal pathologic findings were more likely in women older than age 50 years with abnormal bleeding. Of the 778 patients, 189 were younger than 40 years, and 4 of these 189 women (2.1%) had hyperplasia at final pathologic analysis; none had cancer. Of the 433 patients aged 40 to 49 years, 8 (1.8%) had hyperplasia or cancer. Of the 156 patients aged 50 years or older, 7 (4.5%) had hyperplasia (p = .18); none had cancer. No patient with hyperplasia or morcellated cancer experienced adverse sequelae after a median follow-up of 90.4 months.

In this cohort of patients who underwent laparoscopic SCH, the risk of hyperplasia or malignancy was low. Laparoscopic SCH with morcellation seems to be a low-risk procedure.