Laparoscopy Still Most Popular Hysterectomy Approach After Morcellation Warnings

By Will Boggs MD

April 12, 2019

NEW YORK (Reuters Health) - Laparoscopy remains the most common mode of hysterectomy since an April 2014 U.S. Food and Drug Administration (FDA) warning against power morcellation for laparoscopic specimen removal, according to a database study.

"Following the power morcellation warnings, gynecologic surgeons have found safe alternatives for specimen removal in hysterectomy," Dr. Elisa M. Jorgensen from Beth Israel Deaconess Medical Center and Harvard Medical School, in Boston, told Reuters Health by email. "Most hysterectomies are performed using minimally invasive methods, and these advances have continued to grow following the morcellation safety warnings."

"Several studies reported an initial increase in abdominal hysterectomy following the power morcellation safety concerns," she said. "However, this did not reflect our experience as gynecologic surgeons, and we sought to look at the longer-term impact to see if these reports were sustained over time."

To investigate, Dr. Jorgensen's team used data from the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files.

Overall, during this interval, the proportion of hysterectomies performed laparoscopically increased and the proportion of abdominal and vaginal hysterectomies decreased. Laparoscopy was the most common mode of hysterectomy in every quarter included in the study.

Between the December 2013 article in the Wall Street Journal that first raised safety concerns regarding dissemination of occult gynecologic malignancy with power morcellation and the FDA safety communication, abdominal hysterectomy increased 1.1% per quarter.

The proportion of abdominal hysterectomies remained stable until March 2015, after which the proportion of abdominal hysterectomies decreased by 0.8% per quarter through the end of 2016.

The overall proportion of vaginal hysterectomies decreased from 17.3% of all hysterectomies in the first quarter of 2012 to 15.2% in the fourth quarter of 2016, the researchers report in the April issue of Obstetrics and Gynecology.

The overall proportion of supracervical hysterectomies showed the most persistent changes, decreasing from 13.2% before the Wall Street Journal article to 7.4% within one year and to 7.1% beyond one year after the FDA safety communication.

The proportion of supracervical hysterectomies performed abdominally increased from 34.4% before the FDA safety communication to 46.4% after, with an associated decrease in laparoscopic supracervical hysterectomy from 65.6% to 53.6%, respectively.

Perioperative morbidity did not appear to change significantly during this interval.

"Gynecologic surgeons were actually on a path of increasing minimally invasive hysterectomy, the progress of which took a temporary pause as the community figured out alternatives to power morcellation in response to safety concerns, but then went back to its initial path of increasing growth of minimally invasive hysterectomy," Dr. Jorgensen said.

"On a larger scale, this study shows that surgeons, and moreover surgical practice, are dynamic and are influenced by the world around them," she said. "Surgery responds and reacts not only to research and innovation, but also to other external factors, such as safety concerns and media coverage."

SOURCE: https://bit.ly/2Gih2Vt

Obstet Gynecol 2019.

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