The FDA has released a laparoscopic hysterectomy warning regarding morcellation.
Abdominal vs. Laparoscopic Hysterectomy
A hysterectomy surgery involves removing a woman’s uterus. It is considered partial if the upper part of the uterus is removed. Removal of the cervix and uterus is called a total hysterectomy. A radical hysterectomy, typically done when cancer is present, “removes the whole uterus, the tissue on both sides of the cervix, and the upper part of the vagina”. Taking out the ovaries is called an oophorectomy, and salpingectomy concerns the fallopian tubes being removed. Hysterectomy may or may not involve removal of the ovaries and fallopian tubes. The surgery itself can be performed abdominally, with a 5-7 inch abdominal incision, through a “cut in the vagina” (vaginal hysterectomy), or laparoscopically. A laparoscopic hysterectomy is performed with “a surgical instrument with a thin, lighted tube and small camera” using “a few very small incisions”. This may be done with a robot, in robotic-assisted surgery.1 Hysterectomies are generally performed on women with heavy periods, with non-cancerous fibroid tumors, in the case of a dropped uterus (prolapse), or when there is cancer. A hysterectomy may or may not trigger menopause (depending on the removal of the ovaries), and it might not affect a patients “sex life”, but this surgery is not a cure for endometriosis. In the case of ovary removal, hormone therapy may follow. Laparoscopic hysterectomies could involve the use of the morcellation technique, cutting the uterus in smaller sections in order to remove it.2
In 2014, the FDA warned about cancer risk as a result of morcellation. If a patient has “unsuspected cancerous tissue”, it may be spread outside of the uterus by these power devices. It is estimated that “1 in 350 women undergoing hysterectomy…have an unsuspected uterine sarcoma”, such as leiomyosarcoma. Unfortunately, there is no real way to test if this type of cancer is in a patient with fibroids. As a result, “the FDA is warning against the use of laparoscopic power morcellators in the majority of women undergoing…hysterectomy for…fibroids”. Patients who have already had this procedure are urged to contact their doctor if they have symptoms, or if they wish to know if their post-surgical biopsy tests were normal.3 For small uteri, morcellation typically is not necessary, and vaginal hysterectomy is an option that would not usually involve morcellation.4 This procedure may or may not be used in conjunction with a robot, such as the da Vinci robot. Morcellation could be performed in a “protective bag” so as not to spread the cells. This cancer is rare, but patients should be notified of all surgical risks so that they can make informed medical choices.5
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