Laparoscopic Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication - Use Discouraged Due to Increased Risk in Women With Uterine Fibroids

[Posted 04/17/2014]

AUDIENCE: Internal Medicine, Nursing, OB/GYN, Oncology

ISSUE: FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.

It is estimated that 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma. If laparoscopic power morcellation is performed in women with unsuspected uterine sarcoma, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s likelihood of long-term survival. For this reason, and because there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.

BACKGROUND: Laparoscopic power morcellators are medical devices used during different types of laparoscopic (minimally invasive) surgeries. These can include certain procedures to treat uterine fibroids, such as removing the uterus (hysterectomy) or removing the uterine fibroids (myomectomy). Morcellation refers to the division of tissue into smaller pieces or fragments and is often used during laparoscopic surgeries to facilitate the removal of tissue through small incision sites.

RECOMMENDATION: Health care providers and patients should carefully consider available alternative treatment options for symptomatic uterine fibroids. Do not use laparoscopic uterine power morcellation in women with suspected or known uterine cancer.

See the FDA Safety Communication for a complete list of recommendations for health care providers and patients.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

요약해보면

1. 자궁근종인줄 알았는데 자궁육종(암)인 경우가 예상보다 많다.

2. 자궁육종인 경우 복강 내에서 절단하는 과정에서 암이 퍼지게 된다.

3. 그래서 복강경으로 자궁근종 절제를 하고, 근종을 잘게 절단하여 밖으로 꺼낼 수 있게 해주는 기계는 사용을 자제하라.

4. 결국 개복 수술을 할 수 밖에 없네요.