Importance: Uterine leiomyomata or fibroids are the most common pelvic tumor experienced in women. A minimally invasive approach to hysterectomy has proven benefits of cosmesis, lower blood loss, less pain, decreased hospital stay, and faster recovery. The incidence of uterine morcellation, the process of making a uterine specimen smaller for purposes of removal via a minimally invasive approach, has increased for this reason.
Objective: We review the history, techniques, and direct and indirect risks described in the literature, recommendations for appropriate use, and how to counsel patients regarding this procedure.
Evidence Acquisition: A thorough search of PubMed for all current literature was performed. Techniques for morcellation were reviewed. We included studies that addressed the type and incidence of morcellator-associated risks including those addressing the incidence of leiomyosarcoma in patients with presumed uterine fibroids.
Results: We have summarized several techniques to aid the practitioner in performing morcellation procedures and the risks involved. We have summarized all of the current consensus statements regarding the recommendations for use of morcellation and the approach to proper counseling.
Conclusions and Relevance: Morcellation is an effective method of specimen removal that can decrease the need for laparotomy in both benign and malignant conditions. Upon analysis of current data and consensus statements, when possible, morcellation should be performed within a contained environment to minimize any potential tumor spread in the event of an undiagnosed malignancy. Patients should be adequately counseled to make an informed decision regarding undergoing a morcellation procedure. Future methods for enclosed specimen extraction will hopefully change the future of morcellation.
Target Audience: Obstetricians and Gynecologists
Learning Objectives: After completing this CME activity, physicians should be better able to describe the techniques of uterine morcellation in minimally invasive procedures, identify the direct and indirect risks associated with morcellation procedures, compare the recommendations for appropriate use including the current consensus guidelines, and counsel patients regarding morcellation.
*Fellow, †Chair and Robert A. Ross Distinguished Professor, and ‡Professor and Director, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina; and §Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, NC
All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.
Correspondence requests to: Jessica E. Stine, MD, Lineberger Comprehensive Cancer Center, Obstetrics and Gynecology, Campus Box 7572, Chapel Hill, NC 27599. E-mail: firstname.lastname@example.org.