The Answer to Laparoscopic Power Morcellators for Hysterectomy and Myomectomy

It’s in the bag…

There has been a lot or recent talk about the potential risk of power morcellation when it is done within the body cavity. The US Food and Drug Administration (FDA) announced “Laparoscopic power morcellators should no longer be used for hysterectomy or myomectomy in most women with uterine fibroids because of the risk of spreading unsuspected cancerous tissue.” What is the risk for women? The literature previously indicated that the risk of a fibroid being a sarcoma was 1/1000. The current review of the literature may indicate a higher risk of 1/400.

How can doctors screen for sarcomas?

In the words of Dr. Leslie Kardos, “LDH levels, MRI and endometrial biopsies are helpful.”

How do we educate women to be informed?

Start the discussion with your doctor and seek a second opinion prior to undergoing surgery.

How do we continue to provide minimally invasive surgical options for our patients in a safe way?

One solution is morcellation within a secure bag. Dr Kardos has successfully surgically removed a 19 cm uterus robotically and was able to morcellate within a secure bag. Yet other options include removing pathology through a min-laparotomy incision, or through the vagina when feasible.

Single incision robotic surgery offers yet another option.

• Single umbilical incision, virtually scarless surgery
• Less pain
• No need for morcellation

Dr Kardos was the first GYN surgeon to perform single incision robotic surgery in San Francisco.

Both Dr Kardos and Wittenberg are trained in single incision robotic surgery. Pacific Gyn Surgical Group encourages all women facing minimally invasive surgery to know their options and be properly informed on the current topic of morcellation. Most young women with fibroids have benign disease. All women should be informed about their options.