Laparoscopic myomectomy and morcellation: A review of techniques, outcomes, and practice guidelines. (January 2018)

• Record Type: Journal Article
• Authors: Glaser, Laura M.; Friedman, Jaclyn; Tsai, Susan; Chaudhari, Angela; Milad, Magdy
• Is Part Of: Best practice & research. Volume 46(2018)
• Page Start: 99
• Page End: 112
• Publication Date: 2018-01
• Subjects: Laparoscopic myomectomy -- Power morcellation -- Leiomyosarcoma; Gynecology -- Periodicals; Obstetrics -- Periodicals; Genital Diseases, Female; Obstetrics; Gynecology; Obstetrics; Periodicals; 618.05
• DOI: 10.1016/j.bpobgyn.2017.09.012
• Languages: English
• ISSNs: 1521-6934

Abstract

Abstract: Laparoscopic myomectomy is a minimally invasive surgical approach to treat symptomatic uterine fibroids in women wishing for a uterine-sparing procedure. With careful patient selection, these procedures are associated with favorable reproductive outcomes and low perioperative morbidity. Current available methods for specimen retrieval include power and hand morcellation. The 2014 FDA safety warnings regarding power morcellation arose from concerns about the spread of occult malignancy and prompted widespread use of containment systems that may limit spread of myometrial cells. Investigation into the clinical effects of laparoscopic myomectomy and uncontained morcellation on the prognosis and spread of occult leiomyosarcoma has yielded mixed results. Other complications of uncontained power morcellation exist, including the development of parasitic leiomyomas. The FDA safety warnings have greatly influenced trends in benign gynecologic surgery, and survey data reflect trends in providers' opinions of these trends. In conclusion, recommendations for the current practice of laparoscopic myomectomy and morcellation are reviewed. Highlights: Following morcellator restrictions, fewer myomectomies are performed laparoscopically. Many studies report a worsened prognosis for patients with occult malignancy undergoing uncontained morcellation. Myomectomy with morcellation can be safely accomplished by a minimally invasive approach in selected pre-menopausal patients. The use of containment systems is suggested with morcellation; this may limit intraperitoneal spread of myometrial cells. Women undergoing morcellation procedures should be informed of relevant risks and be offered alternative procedures.