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Morcellation and Hysterectomy: Should I Be Worried?

From the Pre-Op Hysterectomy Articles List

Should I worry about morcellation with hysterectomy?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?

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. Even common, seemingly harmless, surgeries like a tonsillectomy or appendectomy have a few unexpected deaths each year.

Here are some statistics about hysterectomies, morcellation, and ULMS:
  • Around 600,000 hysterectomies are performed in the United States each year (a).
  • Morcellation is used in 11% of hysterectomies, or in 110 for every 1,000 (b).
  • Fewer than 1 in 1,000 women with fibroids, or 0.1%, will be found to actually have uterine leiomyosarcoma (ULMS) (c).
  • Death will occur for 1 in 1,000, or 0.17%, of hysterectomies for a benign reason (d).
  • The risk of ULMS is no more than 0.49% (e).
Based on these numbers, the risk of an unsuspecting sarcoma being morcellated is similar to the death rate of a hysterectomy performed for benign reasons. So while it is natural to worry a little about your upcoming hysterectomy, especially when you hear about negative outcomes, you can take a deep breath knowing that your chances of a life-threatening outcome are slim, statistically speaking.

When considering the type of hysterectomy best for you and your health, consider ACOG's report explaining the differences in risks: "Abdominal hysterectomy has an increased risk of morbidity and mortality over minimally invasive surgery". Morbidity (complications) include "infections, bleeding, deep vein thrombosis, nerve injury, and genitourinary and gastrointestinal tract injury. Patients who undergo abdominal hysterectomy have three times the risk of mortality than those who have laparoscopic hysterectomy". Minimally invasive hysterectomy is associated with smaller incisions, fewer complications, less postoperative pain, and shorter hospital stays (f).

If you do find yourself worrying, be sure to seek a second opinion about your procedure. Be sure that both you and your surgeon have thoroughly considered all the possibilities and risks for you. New concerns about the use of morcellation should be balanced with patient outcomes, and surgeons should be expected to proceed with care and consideration.

(a) ACOG Task Force Report Morcellation and Occult Malignancy
(b) Choosing the Route of Hysterectomy for Benign Disease
(c) SGO Position Statement - Morcellation
(d) Hysterectomy: Mortality Linked to Complication Management
(e) JAMA - Evaluating the Risk of Electric Uterine Morcellation
(f) ACOG Task Force Report Morcellation and Occult Malignancy

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

02-26-2014 - 07:24 PM


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