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Indications for morcellation in gynecologic surgery.

William H Parker1

  • 1Department of Reproductive Medicine, UC San Diego School of Medicine, San Diego, California, USA.

Current Opinion in Obstetrics & Gynecology
|December 19, 2017
PubMed
Summary

Tissue morcellation during laparoscopic hysterectomy and myomectomy is often necessary. Removing all residual tissue and cells from the abdomen and pelvis is crucial for successful minimally invasive gynecologic surgery outcomes.

Area of Science:

  • Gynecologic Surgery
  • Minimally Invasive Procedures
  • Surgical Oncology

Background:

  • Laparoscopic hysterectomy and myomectomy frequently involve tissue morcellation.
  • Myometrial cells can persist in the abdomen and pelvis post-myomectomy, regardless of morcellation.
  • Distinguishing leiomyosarcoma (LMS) from benign fibroids preoperatively is challenging.

Purpose of the Study:

  • To review the necessity and implications of tissue morcellation in minimally invasive gynecologic surgery.
  • To address concerns regarding cancer spread during morcellation of presumed benign fibroids.
  • To emphasize the importance of complete residual disease removal in gynecologic procedures.

Main Methods:

  • Review of current literature on tissue morcellation in laparoscopic gynecologic procedures.

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  • Analysis of myometrial cell dissemination and residual disease following myomectomy.
  • Discussion of leiomyosarcoma (LMS) characteristics and surgical management.

    • Main Results:

    • Residual myometrial cells are present post-myomectomy, with or without morcellation.
    • Containment bags are not essential for removing residual tissue; meticulous cleaning is effective.
    • The concern of 'cutting-through' cancer is often overstated and irrelevant for LMS in minimally invasive gynecologic surgery.
    • Complete removal of all tissue and cells from the abdominal and pelvic cavity should be the primary surgical goal.

    Conclusions:

    • Tissue morcellation is often required for women undergoing laparoscopic myomectomy or hysterectomy for symptomatic fibroids.
    • Leiomyosarcoma (LMS), though rare, has a poor prognosis due to early metastasis and high recurrence rates.
    • The priority in minimally invasive gynecologic surgery, including procedures involving morcellation, is the complete elimination of residual disease.