Is There a Future for Morcellation in Gynecologic Surgery?

An expert interview with Jubilee Brown, MD, member of the board of trustees for AAGL - Advancing Minimally Invasive Gynecology Worldwide

Stephanie Cajigal; Jubilee B. Brown, MD

Disclosures

April 25, 2014

Medscape: Who will the task force include?

Dr. Brown: A very select group of 15 individuals who are leaders in the field, who not only have performed these procedures but who also have substantial expertise in the field of gynecology, minimally invasive surgery, and gynecologic oncology. We feel that this group of physicians really is the best group to scientifically and critically evaluate all of the data. The task force was very carefully selected in terms of choosing experts in the field who are able to best contribute to this discussion. We'll be reviewing all available literature in terms of the risk-benefit profile of alternatives that have been discovered and analyzed. The goal of the task force is to conduct the most rigorous scientific review of data and make heads or tails of what to do with these data.

Medscape: When do you plan to release your analysis?

Dr. Brown: As quickly as possible. The task force has met and is well on its way to establishing the final product.

Medscape: In the meantime, how should gynecologic surgeons interpret the FDA's announcement?

Dr. Brown: Physicians should continue to offer the best options for their patients. Individual physician decisions should be made in consultation with patients. All physicians should look at the FDA statement, but the AAGL at this point is not in agreement with a global ban or moratorium on morcellation. We feel that additional information is needed.

In regard to preoperative workup, physicians should follow American College of Obstetricians and Gynecologists (ACOG) guidelines[4] regarding which patients should be screened with endometrial sampling, based on age and symptomatology, and which patients should not be considered candidates for morcellation due to a concern for malignancy. In regard to the relative significance of these risk factors, which may include abnormal bleeding and uterine size, we'll look to the task force to provide guidance.

Medscape: What additional research needs to be done in this area?

Dr. Brown: The sort of research that the task force is involved in includes safer methods of tissue extraction, patient selection, and product development with (hopefully) improvements in the technology available to our patients.

We have to establish the relative risks and benefits of the different types of morcellation procedures compared with open surgery. The benefits that I think often get left off in these discussions are the improvements in morbidity and mortality with minimally invasive surgery as compared with open surgery. Those benefits really need to be quantified. Second, we have to know whether there is a safer way to perform these procedures.

Medscape: What's the takeaway for gynecologists?

Dr. Brown: To not throw the baby out with the bathwater -- that, again, minimally invasive surgery really affords substantial benefit in patient outcomes. I really don't want that message to get lost. Let's not stop thinking about minimally invasive surgery for the treatment of our patients who need hysterectomy. We need to continue to do research to evaluate the safest and best methods of tissue extraction, which may include morcellation.

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