Power morcellation—An emerging risk complicating minimally invasive surgery for uterine mesenchymal neoplasms

Abstract

Study objective: To determine the local incidence and clinical consequences of myoma, after intraperitoneal dissemination via morcellation. Materials and methods: An electronic search for laparoscopic myomectomies in the computer database of the KK Women's and Children's Hospital (Singapore) and sarcomas or myomata with atypical features in the National Cancer Registry (Singapore) was performed for a 10-year study period. The identified patients had their medical records were traced and their data were extracted and studied in detail. Results: The incidence of unexpected diagnosis (i.e., variants, atypia, and malignancy) was 0.23%, and the incidence of unexpected sarcoma was 0.10%. One of four patients who underwent a subsequent laparotomy had peritoneal dissemination. She unfortunately was also the only mortality in this study. Conclusion: Laparoscopic surgery had proven benefits over open surgery, although the dissemination of unexpected malignancy and extrauterine seeding were major concerns. To date, morcellation in the endobag or cutting the specimen using a knife or scissors may be alternative surgical techniques.

Keywords

• myoma with atypical features
• power morcellation
• sarcoma