TY - JOUR
T1 - Morcellation of undiagnosed uterine sarcoma
T2 - A critical review
AU - Bogani, Giorgio
AU - Chiappa, Valentina
AU - Ditto, Antonino
AU - Martinelli, Fabio
AU - Donfrancesco, Cristina
AU - Indini, Alice
AU - Lorusso, Domenica
AU - Raspagliesi, Francesco
PY - 2016/2/1
Y1 - 2016/2/1
N2 - In the recent decades, laparoscopy has replaced open abdominal procedures in the setting of gynecologic surgery. Extraction of large specimens (e.g., large uteri or myomas) following operative laparoscopy is technically challenging. Technological attempts allow the removal of large and solid pelvic masses via small abdominal incisions (using instruments called morcellators), thus reducing unnecessary laparotomies and improving short-term patients' outcomes. However, morcellation of undiagnosed uterine malignancies may lead to worse survival outcomes. Therefore, the Food and Drug Administration (FDA) warns about the use of power morcellators, thus causing ongoing concerns on the applicability of minimally invasive approaches for myomectomy and the removal of large uteri. In the present review, we sought to assess pro and cons regarding minimally invasive morcellation. This review will discuss the effects of morcellation of undiagnosed uterine malignancies, focusing on possible techniques for preoperative detection of uterine sarcoma and for avoiding intra-abdominal dissemination of potentially malignant tissues. Further efforts are necessary in order to identify tools to make a more accurate and reliable preoperative diagnosis of uterine masses. However, on the light of the current evidence, intra-abdominal morcellation should be banned from clinical practice.
AB - In the recent decades, laparoscopy has replaced open abdominal procedures in the setting of gynecologic surgery. Extraction of large specimens (e.g., large uteri or myomas) following operative laparoscopy is technically challenging. Technological attempts allow the removal of large and solid pelvic masses via small abdominal incisions (using instruments called morcellators), thus reducing unnecessary laparotomies and improving short-term patients' outcomes. However, morcellation of undiagnosed uterine malignancies may lead to worse survival outcomes. Therefore, the Food and Drug Administration (FDA) warns about the use of power morcellators, thus causing ongoing concerns on the applicability of minimally invasive approaches for myomectomy and the removal of large uteri. In the present review, we sought to assess pro and cons regarding minimally invasive morcellation. This review will discuss the effects of morcellation of undiagnosed uterine malignancies, focusing on possible techniques for preoperative detection of uterine sarcoma and for avoiding intra-abdominal dissemination of potentially malignant tissues. Further efforts are necessary in order to identify tools to make a more accurate and reliable preoperative diagnosis of uterine masses. However, on the light of the current evidence, intra-abdominal morcellation should be banned from clinical practice.
KW - Hysterectomy
KW - Laparoscopy
KW - Minimally invasive
KW - Morcellation
KW - Robotic
KW - Sarcoma
UR - http://www.scopus.com/inward/record.url?scp=84957427063&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84957427063&partnerID=8YFLogxK
U2 - 10.1016/j.critrevonc.2015.11.015
DO - 10.1016/j.critrevonc.2015.11.015
M3 - Article
AN - SCOPUS:84957427063
VL - 98
SP - 302
EP - 308
JO - Critical Reviews in Oncology/Hematology
JF - Critical Reviews in Oncology/Hematology
SN - 1040-8428
ER -