Minimally invasive uterine and fibroid morcellation warnings

In recent months there have been a number of warnings issued about uterine polyp and fibroid morcellation during laparascopic hysterectomy or myomectomy, most notably by the FDA in the United States. It’s come about because in a small number of cases the fibroids being removed were shown to be malignant after the surgery, something that was not known prior to the operation. In a few of these cases women went on to develop leiomyosarcoma (cancer of the uterine wall).

It is important to remember that the vast majority of fibroids are not cancerous and women undergoing this treatment never develop any further side effects. In fact, one study in 1994 showed that the risk of leiomyosarcoma among women operated on for “fibroids” was just 1 in every 1,332(1).

A morcellator is a bladed instrument with a suction tube that is inserted through a hysteroscopy and used to simultaneously cut and remove fibroids and polyps from the uterine cavity. Since it doesn’t use any heat or energy there is no risk of damage to the inner lining of the womb which helps to preserve the chance of a successful pregnancy in the future. It also shortens the time taken to operate and can be performed as an outpatient; recovery is much quicker and for suitable women it has proved to be a great alternative treatment.

However, in light of the FDA warnings and following a review, NICE (the National Institute for Health and Care Excellence) have decided to withdraw the current guidance which was published in April 2014 and will be providing additional guidance in early 2015.  You can find out more about this decision here:

(1. Parker, W., Fu, Y.F., Berek, J. Uterine Sarcoma in Patients Operated on with Presumed Leiomyoma and Rapidly Growing Leiomyoma. Obstetrics and Gynecology. March 1994; 83:414-418.)

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