Morcellation of undiagnosed uterine sarcoma: A critical review

Giorgio Bogani, Valentina Chiappa, Antonino Ditto, Fabio Martinelli, Cristina Donfrancesco, Alice Indini, Domenica Lorusso, Francesco Raspagliesi

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
Pages (from-to)302-308
Number of pages7
JournalCritical Reviews in Oncology/Hematology
Volume98
DOIs
Publication statusPublished - Feb 1 2016

    Fingerprint

Keywords

  • Hysterectomy
  • Laparoscopy
  • Minimally invasive
  • Morcellation
  • Robotic
  • Sarcoma

ASJC Scopus subject areas

  • Oncology
  • Hematology
  • Geriatrics and Gerontology

Cite this