COMMENTARY

Is It Time to Revisit Uterine Morcellation?

Andrew M. Kaunitz, MD

Disclosures

April 07, 2014

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Publicity surrounding the use of electric morcellation to facilitate minimally invasive hysterectomy in a woman with previously undiagnosed sarcoma has led some to question routine use of this practice.[1] Morcellation involves cutting fibroid or uterine tissue into small pieces to allow removal without a large incision, and it has facilitated the increase in use of minimally invasive approaches for hysterectomy. In the highly publicized case, the dispersion of tissue fragments associated with morcellation presumably upstaged the patient's malignancy.[2] Given that the 5-year survival associated with leiomyosarcoma decreases from 60% for women with stage I disease to 15% for those with advanced disease, concerns about upstaging when morcellation is performed in the setting of previously undiagnosed sarcoma are understandable.

Unfortunately, few data address the prevalence of sarcoma in women undergoing hysterectomy for symptomatic uterine fibroids, and preoperative imaging does not reliably make this diagnosis. This unfortunate case illustrates the importance of informed consent prior to using morcellation. Consent in this setting includes informing the patient about the remote, but real, risk of upstaging a uterine sarcoma.

The current controversy surrounding the use of electric morcellation for minimally invasive hysterectomy is increasing the attention being paid to tissue extraction alternatives, including manual or electronic morcellation within an endoscopic bag and specimen removal either through laparoscopic-aided mini-laparotomy or through a vaginal incision.[2] Thank you. I am Andrew Kaunitz.

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