Hysterectomy and Myomectomy
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The Debate: Morcellation During Hysterectomy or Myomectomy
Morcellation during a gynecologic surgery is a controversial topic. One of the biggest concerns, based on one woman’s recent experience, is the possibility of spreading undiagnosed cancer, specifically uterine leiomyosarcoma (ULMS), during minimally invasive surgery (MIS) with morcellation. Because of this woman’s experience, there has been discussion within the medical community about banning or curbing the use of morcellation altogether, which may have negative affects on other women and the surgical—hysterectomy or myomectomy—choices available to them for the best outcomes.
Though we do not claim to be medical professionals, HysterSisters.com aims to provide you with facts that can help you make the best decisions for your health....Read more about The Debate About Morcellation and Cancer Risk.
Should I Be Worried?
I've heard of a woman who is claiming that morcellation during her hysterectomy spread her uterine leiomyosarcoma and worsened her prognosis. Should I be worried that the same will happen to me? Should I avoid morcellation?
In reality, the practice of medicine is an ongoing experiment. The tricky part is that no two patients are the same; thus, the variables in this experiment are endless. For us, this means that there is always at least a small risk. A treatment that works for 999 people may not work for the next person that walks in the door. And in many cases, no one—not even the doctor—can be blamed.
Doctors are constantly making adjustments to their practice based on new research, but there will still be a small percent of procedures that have a negative outcome.....Read more about Should I be Worried About Morcellation?.
What Is Morcellation?
Morcellation means cutting an object or tissue into smaller pieces for removal. When it comes to gynecology, it could mean cutting up the uterus, polyps, tumors, or fibroids so they can be removed through a smaller opening.
Surgeons have several different options for morcellation tools. There are power tools, such as the specifically-designed morcellator, and then there are the manual tools like the scalpel. The decision mostly depends on the surgeon’s preference and your specific situation. Some tools have the ability not only to cut, but also to core and extract tissues. Morcellation can either be done in a closed environment, such as a bag, or in an open environment such as the uterus, pelvic cavity, or abdominal region. Using morcellation during hysterectomy has many benefits....Read more about Morcellation.
What Is the Purpose of Morcellation with a Hysterectomy?
Morcellation is the process of cutting the uterus and other tissues into tiny pieces that can be removed through tiny incisions. It may sound a little gory, but it can be very beneficial for some women.
If you have an enlarged uterus or large fibroids, for instance, morcellation can give you the option of having a minimally invasive surgery (MIS)—an option that minimizes wound issues and scarring. Where once the only option for these conditions was an abdominal surgery, morcellation can now allow surgeons to remove these parts through either smaller incisions or the vagina....Read more about Purpose of Morcellation During Hysterectomy.
Morcellation and Myomectomy
Morcellation during a gynecologic surgery, such as a myomectomy, is a controversial topic. As with any type of surgical procedure, there are benefits and risks to morcellation, so you'll need to work with your medical team to determine if it is right for you.
For those with fibroids who would like to retain their uterus, and especially for those who would like to retain fertility, morcellation can be beneficial in a number of ways. For one, it offers a means of using minimally invasive surgery (MIS), which usually means less pain, scarring, and tissue trauma as well as quicker healing, recovery, and return to normal activities. In addition, MIS tends to result in less blood loss and a less chance of infection....Read more about Morcellation and Myomectomy.
What Are the Risks of Morcellation?
While there are many benefits of morcellation, there are some risks as well. Because some of these risks could involve cancer and other serious health issues, it is important that you are informed before you agree to the process.
During morcellation, tissues are cut into tiny pieces. This can be done in a "closed" or "open" environment—both are inside the body, but one attempts to contain tissue debris and the other does not. In an open environment, bits of tissue can stray from the original site. These cells can then remain in the abdominal or pelvic region, or even find their way into the incision sites. If these cells contain genetic mutations, find a blood supply, and/or have growth potential, they can cause future issues. This can be especially concerning if the tissues contain previously undiagnosed cancer. In this case, the prognosis becomes much more grave--the tumor may need to be upstaged and more surgery and treatment could be required...Read more about Risks of Morcellation.
Morcellation and FDA Guidelines
In a safety communication issued on November 24, 2014, the FDA did not ban the use of power morcellators. Instead, the FDA indicated that they believe the risk of women with fibroids having an undetected uterine sarcoma is higher than previously thought, so most women should not undergo morcellation for the treatment of uterine fibroids. They further stated that two groups of women should not undergo morcellation. These are peri- and post-menopausal women with fibroids, and women who have known or suspected cancer...Read more about Morcellation | FDA Guidelines.