Release Date: 08/18/2014
This spring, the U.S. Food and Drug Administration (FDA) issued a statement discouraging the use of laparoscopic power morcellation for the removal of the uterus or uterine fibroids, citing that the procedure poses risks of spreading undetected cancerous tissue. Since then, there has been much debate about the risks and benefits of using this technique.
An editorial by Charles Rardin, MD, a urogynecologist in the Division of Urogynecology and Reconstructive Pelvic Surgery and director of the Robotic Surgery Program for Women at Women & Infants Hospital of Rhode Island, director of Minimally Invasive Surgery at Care New England, and associate professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University, entitled "Mitigating Risks of Specimen Extraction – Is In-Bag Power Morcellation an Answer?," is published this month in Obstetrics & Gynecology.
"In use for more than 20 years, the technique of power morcellation has brought minimally invasive surgery to women with gynecologic issues requiring surgery, reducing the incidence of laparotomy, or 'open' surgery. This has resulted in reduced postoperative pain and recuperation time, and, by many studies' estimation, reduced rates of pelvic infection, incisional hernia, thromboembolic disease, and adhesion formation," said Dr. Rardin.
A morcellator is a surgical instrument that is used during laparoscopic surgery to "mince up" and remove large masses of tissue. In laparoscopic hysterectomy, the uterus is morcellated into smaller pieces inside the woman's belly cavity and then extracted from the abdomen.
"Few would argue that tissue morcellation of known cancerous tissue is a poor surgical strategy," continued Dr. Rardin. "But until there are more effective screening tools to detect unusual or undetected cancers, surgeons and hospitals need to develop appropriate responses that attempt to mitigate the risk of tissue spread during power morcellation procedures."
Rardin, who also published a clinical opinion in the American Journal of Obstetrics & Gynecology in the spring, entitled "The Debate Over Robotics in Benign Gynecology," is a proponent of a balanced approach to minimally invasive surgery.
"Regardless of how surgeons and institutions seek to engage in safer power morcellation techniques, it behooves all surgeons to remember and retain our knowledge and skill in other forms of minimally invasive surgery, including vaginal hysterectomy with extraction techniques," he said. "Although comparative data are lacking, certain techniques of vaginal tissue extraction should keep any risk of dissemination to a minimum while preserving the patient's benefits from the original minimally invasive surgery."
This year, Women & Infants Hospital was designated a Center of Excellence in Minimally Invasive Gynecology (COEMIG) by the Surgical Review Corporation, an affiliate of the American Association of Gynecologic Laparoscopists (AAGL), for its commitment to offering women the most effective diagnostic and therapeutic techniques in minimally invasive surgery.
Obstetrics & Gynecology is the official publication of the American College of Obstetricians and Gynecologists (the College). Popularly known as "The Green Journal," Obstetrics & Gynecology has been published since 1953. Then as is now, the goal of the journal is to promote excellence in the clinical practice of obstetrics and gynecology and closely related fields.
Obstetrics & Gynecology reaches over 45,000 members and non-member subscribers.
About Women & Infants Hospital
Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation’s first mother-baby perinatal psychiatric partial hospital, as well as the nation’s only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Imaging Center of Excellence by the American College of Radiography; a Center of Excellence in Minimally Invasive Gynecology; a Center of Biomedical Research Excellence by the National Institutes of Health (NIH); and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute’s Gynecologic Oncology Group and the Pelvic Floor Disorders Network.