Power morcellation and unexpected uterus malignomas

Introduction: Due to the development of MIC electromechanical morcellation (EMM) became a routine technic. Despite the important advantages of morcellation it may be associated with dissemination of uterine tissue throughout the peritoneal cavity and spread of an occult malignoma, which can result in cancer upstaging. Our aim is to estimate the frequency of the appearance of unexpected malignomas in morcellation and its clinical impacts in a patient cohort in our department.

Materials and methods: This retrospective study included patients treated from 2008 – 2015. We identified women who underwent laparoscopically or robotically myomectomy or hysterectomy because of symptomatic myomas and use of EMM.

Results: We analyzed 421 patients who had LSH (50.2%), TLH (18.1%) or myomectomy (31.7%). Unexpected malignancy was detected in 3 of 421 patients, which represents 0.71%. In all three cases the malignancy was proved to be sarcoma. We treated the patients with a re-operation for completion of staging. Up to now no intrabdominal recurrence appeared (follow up 22,35 respectivelyy 60 months).

Conclusion: There is an inherent risk of spread out of occult malignoma in EMM. In clinical management detailed patients' information about risk of EMM and alternatives are mandatory. Risk factors for presence of occult malignancies have to be considered. In high-risk patients, EMM should be avoided. In future morcellation bags should be used routinely. The outcome in case of morcellated malignomas keeps unclear.