Severe direct and indirect complications of morcellation after hysterectomy or myomectomy

Despite the significant advantages of morcellation, it may be associated with severe complications. We aimed to determine both direct and indirect complication rates of morcellation at gynecological laparoscopy. This multicenter retrospective study included patients traced from 2008 to 2017. We iden...

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Bibliographic Details
Published in:Minimally invasive therapy and allied technologies 2022-03, Vol.31 (3), p.418-425
Main Authors: Gitas, Georgios, Alkatout, Ibrahim, Allahqoli, Leila, Rody, Achim, Ertan, A. Kubilay, Grimbizis, Grigoris, Baum, Sascha
Format: Article
Language:English
Subjects:
complications
Female
Humans
Hysterectomy - adverse effects
Laparoscopy - adverse effects
Morcellation - adverse effects
Power morcellation
Retrospective Studies
sarcoma
transvaginal morcellation
unexpected malignancy
Uterine Myomectomy - adverse effects
Uterine Neoplasms - surgery
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Summary:Despite the significant advantages of morcellation, it may be associated with severe complications. We aimed to determine both direct and indirect complication rates of morcellation at gynecological laparoscopy. This multicenter retrospective study included patients traced from 2008 to 2017. We identified women who underwent an operation with the use of electromechanical power morcellation (EMM) or vaginal manual morcellation during laparoscopy. Clinical records, intraoperative-postoperative outcomes were reviewed. We analyzed 1795 patients who underwent laparoscopic supracervical hysterectomy (LASH), total hysterectomy (TLH), or myomectomy (45.5%, 14.2%, and 40.3%, respectively). No severe intraoperative complications associated with morcellation or parasitic leiomyoma were observed. Patients with unexpected sarcoma were detected in five cases (0.28%). Four of them were detected after LASH and one after vaginal manual morcellation following TLH, who had an intraabdominal recurrence and died after 18 months. The patients after LASH underwent secondary laparotomy for staging; no histological dissemination of sarcoma was observed, however two had a recurrence. The five-year survival rate was 80%. There is a small risk of intraoperative complications or unexpected malignancy following morcellation, provided the surgeon adheres to regular surgical standards. In patients with a normal size uterus, TLH could be preferred over LASH to avoid morcellation.
ISSN:1364-5706
1365-2931
DOI:10.1080/13645706.2020.1802292