Morcellation Should Be Banned, Harvard Surgeon Says

An Expert Interview With Hooman Noorchashm, MD, PhD

Stephanie Cajigal; Hooman Noorchashm, MD, PhD

Disclosures

June 10, 2014

Editor's Note: In October 2013, Amy Reed, MD, PhD, underwent a hysterectomy procedure involving morcellation at Brigham & Women's Hospital in Boston for what was presumed to be benign fibroids. All went fine until about 1 week later, when Dr. Reed, an anesthesiologist at Beth Israel Deaconess Hospital in Boston, received a phone call informing her that she had actually had a leiomyosarcoma, and that the procedure may have upstaged it to stage IV cancer.

Dr. Reed and her husband, Hooman Noorchashm, MD, PhD, a lecturer on surgery at Harvard Medical School and a cardiothoracic surgeon at Brigham and Women's Hospital, are now on a mission to ban the practice of morcellation in any form. Their change.org petition has so far received over 9000 signatures.

Dr. Noorchashm spoke with Medscape about the morcellation alternatives that he feels gynecologic surgeons need to consider.

Medscape: Why did you decide to launch this campaign?

Dr. Noorchashm: Before my wife had her operation, she had undergone pretty extensive testing, which included an MRI. She had 2 ultrasounds and an endometrial biopsy. She was reassured and cleared by a very reputable gynecologic oncologist, as well as the radiologist at Brigham and Women's Hospital -- which is one of Harvard's main medical centers, and probably one of the top 3 gynecology training programs in the country.

Then she was offered a laparoscopic hysterectomy. It took about 2 hours, and she was discharged the same day. She was on her feet 2 days later. Everything, by all accounts, had gone as planned. About a week later, she was told she had a pretty aggressive leiomyosarcoma and that the morcellation had spread this cancer throughout her abdomen and pelvis.

This technique's potential for spreading cancer was not part of the informed consent process at all. We realized that the gynecology specialty as a whole really had no good way of identifying women with these so-called uterine sarcomas. That was very clear from the work-up Amy herself had.

Then we found out that morcellation is a standard of care, and it is practiced on more than 100,000 women per year in the United States and probably more globally.[1] It was very clear to us that we needed to do everything in our power to stop this.

We received almost no cooperation from the American Congress of Obstetricians and Gynecologists (ACOG) and the Brigham and Women's Hospital initially. My wife and I felt that, as physicians and now as patients, we had a moral obligation to prevent any more families from being exposed to this senseless harm.

Medscape: How is your wife doing now?

Dr. Noorchashm: She underwent a cytoreduction and hyperthermic intraperitoneal chemotherapy operation by Dr. Paul Sugarbaker in Washington, DC. That's not a standard of care for leiomyosarcoma, but we are pretty confident that the procedure did quite extensive debulking and locally treated the cancer, the sarcoma, with chemotherapy. She has since received 6 cycles of gemcitabine and docetaxel, and she tolerated that pretty well. In fact, she is hopefully going back to work.

Chemotherapy alone has very poor outcomes for metastatic sarcoma. We are hoping that by going outside the box in terms of what the routine therapies are, we've made a difference here -- that we've done a damage control operation.

Medscape: What specifically do you hope your campaign will achieve?

Dr. Noorchashm: There are 3 things we're reaching for. The first is to end morcellation. The second is correcting the surgical training that gynecologists receive. The third is reestablishing the basic ethical principle of nonmaleficence.

The first issue, first and foremost, is that the specialty of gynecology has to stop morcellating tissues that have malignant potential inside women's bodies, because it's simply an incorrect and dangerous practice. It's unethical to do this, and it's deadly to 1 in 350 women.[2] That's a number that's calculated by a group of public health experts at the US Food and Drug Administration (FDA).

Medscape: Are you interested in banning both power morcellation and manual morcellation?

Dr. Noorchashm: The act of morcellating any tissue with malignant potential -- be it with a scalpel, electrical cautery, power morcellator, or "a fork and a knife" -- is a surgically dangerous thing to do when you do it inside a woman's body cavity, because if there's cancer there, it will spread, no matter what the frequency of malignancy happens to be: 1 in 350, or 1 in 1000.

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