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uterine morcellation

Indications: - fibroids Contraindications: - use discouraged with hysterectomy or myomectomy [7] Procedure: - laparoscopic procedure that grinds fibroids Complications: - metastasis of occult endometrial cancer ? [1] - overall risk of undiagnosed uterine cancer at the time hysterectomy = 0.03% [4] - 5 times higher in women age 50-54 & 36 times higher in women > 65 than in women < 40 [4] - use of an isolation bag for power morcellation seems promising [6] - potential harms of decreasing rates of minimally invasive surgery facilitated by uterine morcellation needs to be weighed against risk of disseminating occult endometrial cancer [12] Notes: - Cleveland Clinic, University of Pennsylvania Health System, Brigham and Women's Hospital, & Massachusetts General Hospital have halted use of morcellation procedures during FDA investigation [2] - panel of FDA advisors recommend black box warning or all-out ban of morcellators for removal of fibroids [3] - no evidence that using containment bags with morcellators can lower the risk for cancer spread [3] - J&J withdraws power morcellators from the market [5] - power morcellation use has diminished by 80% following FDA advisory [9]

General

morcellation

References

  1. Physician's First Watch, Dec 19, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  2. Young K Several Hospitals Stop Using Morcellators for Uterine Fibroids Following FDA Warning. Physician's First Watch, April 25, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  3. Sadoughi S and Sofair A Physician's First Watch, July 14 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  4. Wright JD et al Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation. JAMA. Published online July 22, 2014. PMID: 25051495 http://jama.jamanetwork.com/article.aspx?articleid=1890400
  5. Physician's First Watch, Aug 1, 2014 J&J Withdraws Power Morcellators David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  6. Cohen SL et al. Contained power morcellation within an insufflated isolation bag. Obstet Gynecol 2014 Sep 15; 124:491 PMID: 25162248 http://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9000&issue=00000&article=99365&type=abstract
  7. FDA MedWatch: 11/24/2014. Laparoscopic Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication - Use Discouraged Due to Increased Risk in Women With Uterine Fibroids. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm393809.htm
  8. Orciari Herman A, Sofair A, Chavey WE FBI Enters Uterine Morcellator Debacle Physician's First Watch, May 29, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
  9. Wright JD et al. Trends in use and outcomes of women undergoing hysterectomy with electric power morcellation. JAMA 2016 Aug 23/30; 316:877 PMID: 27552622
  10. Zaritsky E, Tucker LY, Neugebauer R et al. Minimally invasive hysterectomy and power morcellation trends in a West Coast integrated health system. Obstet Gynecol 2017 Jun; 129:996. PMID: 2848635 - Ottarsdottir H, Cohen SL, Cox M, Vitonis A, Einarsson JI. Trends in mode of hysterectomy after the U.S. Food and Drug Administration power morcellation advisory. Obstet Gynecol 2017 Jun; 129:1014. PMID: 28486371 - Stentz NC, Cooney LG, Sammel M, Shah DK. Changes in myomectomy practice after the U.S. Food and Drug Administration safety communication on power morcellation. Obstet Gynecol 2017 Jun; 129:1007. PMID: 28486366 - Hurd WW. On the road to safer morcellation. Obstet Gynecol 2017 Jun; 129:976. PMID: 28486377
  11. FDA Updated Assessment of The Use of Laparoscopic Power Morcellators to Treat Uterine Fibroids. December 2017. https://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/UCM584539.pdf
  12. Multinu F, Casarin J, Hanson KT et al Practice Patterns and Complications of Benign Hysterectomy Following the FDA Statement Warning Against the Use of Power Morcellation. JAMA Surg. Published online April 11, 2018 PMID: 29641835 https://jamanetwork.com/journals/jamasurgery/fullarticle/2678107