Upcoming hysterectomy: Hand morcellation of uterus?

No set date for surgery other than mid February. Plan is for a total hysterectomy including Fallopian tubes laparoscopic assisted. due to my uterus size of 14 weeks with a 6 cm fibroid and a smaller one, she is unsure if she will be able to do it vaginally. If not the plan is to do a hand morcellation and remove through an incision in the belly button. I also had the option of removing it via a bikini line incision but wanted to go the least invasive route. Morcellation will be done contained to reduce the risk of any possible cancerous cells being spread into the abdomen. Upon more research I’m starting to second guess myself. While we don’t expect cancer, she said there is no definitive way of knowing beforehand so my concern is that what if there is a spill or the bag in punctured? Like 1 in around 500 cases turn out to have cancerous cells present. Then if cancer is present testing is more difficult because the uterus has been chopped up? I’m starting to lean back toward abdominal incision. Has anyone had the morcellation done? How did it go? Is the abdominal incision recovery that much longer or difficult? This will be outpatient surgery so I’m nervous. Plus my dad has a very aggressive prostate cancer, both his parents had cancer( lung and colon) and his sister passed at 59 from uterine and ovarian cancer. I’m super paranoid!

	Quote:
Originally Posted by Twentyatheart No set date for surgery other than mid February. Plan is for a total hysterectomy including Fallopian tubes laparoscopic assisted. due to my uterus size of 14 weeks with a 6 cm fibroid and a smaller one, she is unsure if she will be able to do it vaginally. If not the plan is to do a hand morcellation and remove through an incision in the belly button. I also had the option of removing it via a bikini line incision but wanted to go the least invasive route. Morcellation will be done contained to reduce the risk of any possible cancerous cells being spread into the abdomen. Upon more research I’m starting to second guess myself. While we don’t expect cancer, she said there is no definitive way of knowing beforehand so my concern is that what if there is a spill or the bag in punctured? Like 1 in around 500 cases turn out to have cancerous cells present. Then if cancer is present testing is more difficult because the uterus has been chopped up? I’m starting to lean back toward abdominal incision. Has anyone had the morcellation done? How did it go? Is the abdominal incision recovery that much longer or difficult? This will be outpatient surgery so I’m nervous. Plus my dad has a very aggressive prostate cancer, both his parents had cancer( lung and colon) and his sister passed at 59 from uterine and ovarian cancer. I’m super paranoid!

I know if my Dr had said that I would have said no to morcellation. I know that it makes it easier operation, but if any chance there is cancer then it is not worth the risk, in my opinion. In my case it would have been terrible because only the smallest polyp containing cancer would have been cut up and possibly spread. But by having a TAH, yes harder, but all out in one piece, nothing disturbed, nothing left, lowest stage and grade totally contained inside that single polyp, and no further treatment needed.


https://www.nytimes.com/2017/05/24/u...procedure.html

I think you need to make a choice here. Which is more important to you: having the least invasive surgery possible or avoiding morcellation in order to reduce your cancer risks? That's a very personal choice and no one else can make it for you.

What I *can* tell you is that I had an old-fashioned total abdominal hysterectomy - with a vertical incision, even! - and both the surgery and my recovery went very smoothly. Recovery was long but not, at least for me, particularly hard or painful.

	Quote:
Originally Posted by Twentyatheart No set date for surgery other than mid February. Plan is for a total hysterectomy including Fallopian tubes laparoscopic assisted. due to my uterus size of 14 weeks with a 6 cm fibroid and a smaller one, she is unsure if she will be able to do it vaginally. If not the plan is to do a hand morcellation and remove through an incision in the belly button. I also had the option of removing it via a bikini line incision but wanted to go the least invasive route. Morcellation will be done contained to reduce the risk of any possible cancerous cells being spread into the abdomen. Upon more research I’m starting to second guess myself. While we don’t expect cancer, she said there is no definitive way of knowing beforehand so my concern is that what if there is a spill or the bag in punctured? Like 1 in around 500 cases turn out to have cancerous cells present. Then if cancer is present testing is more difficult because the uterus has been chopped up? I’m starting to lean back toward abdominal incision. Has anyone had the morcellation done? How did it go? Is the abdominal incision recovery that much longer or difficult? This will be outpatient surgery so I’m nervous. Plus my dad has a very aggressive prostate cancer, both his parents had cancer( lung and colon) and his sister passed at 59 from uterine and ovarian cancer. I’m super paranoid!

Hello Twentyatheart,
These are difficult decisions to make when there are so many unknowns! I don’t yet know the exact method my surgeon will recommend for me. I am having my complete hysterectomy/BSO because my sister had uterine and ovarian cancer, discovered at the same time. Because of that, and a family history of colon and prostate cancer, her doctor recommended a genetic test. It did reveal Lynch Syndrome, which is a genetic syndrome in which people have a higher risk of certain cancers. I decided to be tested also, and was positive, and decided to have the hysterectomy.

Has your doctor recommended you talk with a genetic counselor at all? It is a personal decision, of course, but it might help you calm your fears about cancer to know the cancers in your family are random. Or if you learned otherwise, help inform this decision, or other future decisions/cancer surveillance. I don’t know how urgent your surgery is, the test does take some weeks.

I’m sure you will determine the best course of action, and will have a lot of support here for your decision! Thank you for sharing!

Jen

Yes she did say she could refer me for genetic counseling. Mostly to help decide if I should keep my healthy ovaries. I think I am going to do the counseling but it won’t be until after the surgery. The counseling could take a while and she can actually get me in for surgery pretty quick which will get me relief. If needed we can go back and remove the ovaries in a second surgery. I’m just surprised that I’m not finding anyone who has had the morcellation. This is a university “teaching” hospital so maybe it’s not that common yet.

Hi Twentyatheart! I'm so sorry to hear of your upcoming surgery. I had a hysterectomy via morcellation and STRONGLY advise against. My surgery was many years ago in 2010 at the age of 33. Lapro surgeries back then didn't make use of the containment bag and I was never given any warnings of possible cancer.
I had a VERY rough surgery. I was measuring 5 months at the time with a very large fibroid. They attempted to remove it vaginally but could not get it out, which is when they opted for morcellation. My situation may have been more complicated because I had fibroid wrapped around my ureters as well. My surgery went 8 hours and I lost a lot of blood. I was in hospital for 5 days and had a transfusion after 2. I ended up with a pelvic infection and a bladder injury which had me with a catheter for almost a month. In the end my recovery had me off work for 2 months. 5 years later I had an emergency appendectomy which was caused by 5-6 masses in my pelvis. The pathology came back as Stage 3 Uterine Leiomyosarcoma. In 2016 I had to remove my ovaries because my tumours were estrogen positive so this was my form of treatment to help stop future growth. I am now needing possible surgery again for a new mass on my liver.

In the end I now have a bikini line scar and to be honest it's barely noticeable. Personally I would choose a 2-3 inch scar over cancer. And the peace of mind. Living every day afterwards never knowing if something escaped isn't how I'd want to live. And there hasn't been enough research done on the containment bag. Follow your gut and be your own advocate. Will be thinking of you.

Morcellation has been around for awhile. In fact, there used to be two kinds, manual morcellation and power morcellation. Power morcellation was implicated in the spread of cancer, so it's not done anymore. The article at Morcellation | FDA Guidelines may be of interest, as well as The Debate about Morcellation and Cancer Risk.

I wonder if rates of manual morcellation have also fallen off as a result of concerns over cancer? It *may* be that more surgeons are recommending abdominal hysterectomies as a result. However, that's just conjecture on my part.

If you do a site search on morcellation, you'll find older threads posted by members who've had or are considering morcellation.

I had an lsh with morcellation (not ground up, the tissue was cut into strips and pulled out thru a wide incision in my navel). The cutting was done inside the bag. I felt my cancer risk was low and with the bag there was very minimal risk. Your are right the bag could be defective or be cut during your procedure. As far as I know they are able to do a full pathology test on your tissue with this method. My results were negative. I do understand your concerns I had declined a myomectomy for my largest fibroid before because the option was to power morcellate and no bag because it would be done inside my uterus. I was worried tissue would get loose in my uterus and even though the cancer risk is small it’s still there.

It’s unfortunate that we can’t have all the information we need to make these decisions so you have to go with what you think the right one is for you. And ask your doc all the questions you have and I would go for the genetic counseling if you think it will help you make a decision.

The procedure will be done in a bag and by hand with scalpel. That way it doesn’t spread cells into the abdomen.