The Food and Drug Administration (FDA) is discouraging use of laparoscopic power morcellation procedures for hysterectomies and myomectomies (removal of uterine fibroids) due to the risk of spreading undetected cancer and worsening the odds of survival. But even in patients without cancer, the procedure can spread benign uterine disease resulting in morbidity and the need for more extensive surgeries, according to a study published in the journal Obstetrics & Gynecology.
Power morcellators are surgical tools that are used to shred uterine fibroids or entire uteruses inside the body and remove them through small incisions in the abdomen. The devices are less invasive than traditional open surgeries and thus leave less scarring and offer less recovery time. As a result they have been used about 50,000 times a year since the devices were introduced more than two decades ago.
Under pressure from physicians and advocacy groups, the FDA launched an investigation into claims that the device can spread undetected cancer throughout the abdomen and found that the devices could cause cancer to spread, making it more difficult to treat. Because there is no reliable way to diagnose uterine sarcoma in women before the uterine fibroids or uterus is removed, the agency last month issued a warning to physicians that the surgical tools should not be used in the vast majority of women due to the risk of cancer spreading and disease worsening.
New research shows that even in women without cancer, risk of chronic injuries remains. Researchers from Johns Hopkins Hospital’s Department of Gynecology and Obstetrics reported that while rare, past case reports have described the spread of endometriosis after power morcellation.
The cases reported in the study involved three woman who had had previous laparoscopic hysterectomies with power morcellation for benign disease. The women each presented with symptoms six to 12 months after their procedures during which exploratory laparotomy was performed and extensive organ resection or radical dissection was performed to remove their disease. Pathology results showed that benign disease in all three woman had spread to the abdomen.
The authors urge surgeons to perform thorough preoperative workup in women to rule out malignancy and to appropriately counsel women of the risks involved with power morcellation before the procedures are performed.