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Published on: January 17, 2019
Severe direct and indirect complications of morcellation after hysterectomy or myomectomy
Georgios Gitas1, Ibrahim Alkatout2, Leila Allahqoli3
1Department of Obstetrics and Gynecology, University Hospital Schleswig Holstein, Luebeck, Germany.
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.
Insights
Morcellation during gynecological laparoscopy has a low risk of complications and rare instances of unexpected malignancy. Total laparoscopic hysterectomy may be preferred over laparoscopic supracervical hysterectomy for smaller uteri to avoid morcellation.
Area of Science:
- Gynecologic Surgery
- Surgical Oncology
Background:
- Morcellation offers significant surgical advantages but carries risks of severe complications.
- Assessing direct and indirect complication rates of morcellation in gynecological laparoscopy is crucial.
Purpose of the Study:
- To determine complication rates associated with morcellation during gynecological laparoscopy.
- To evaluate the incidence of unexpected malignancy and its outcomes.
Main Methods:
- Multicenter retrospective study (2008-2017) of 1795 patients.
- Inclusion of patients undergoing electromechanical power morcellation (EMM) or vaginal manual morcellation.
- Review of clinical records and intraoperative-postoperative outcomes.
Main Results:
- No severe intraoperative complications or parasitic leiomyomas observed.
- Five cases (0.28%) of unexpected sarcoma detected, with a 5-year survival rate of 80%.
- Two recurrences noted in patients who underwent secondary laparotomy after LASH.
Conclusions:
- Morcellation carries a small risk of complications and unexpected malignancy when standard surgical practices are followed.
- Total laparoscopic hysterectomy (TLH) may be preferable to laparoscopic supracervical hysterectomy (LASH) for normal-sized uteri to mitigate morcellation risks.
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