POV – Power Morcellation
Morcellation means cutting an object or tissue into smaller pieces for removal. When it comes to gynecology, it could mean cutting up the uterus, polyps, tumors, or fibroids so they can be removed through a smaller opening.
ACOG Statement on Power Morcellation
November 24, 2014
Washington, DC – Hal C. Lawrence, MD, Executive Vice President and CEO of the American College of Obstetricians and Gynecologists (ACOG), released the following statement addressing the Food and Drug Administration’s Immediately-in-Effect guidance regarding power morcellators:
“The American College of Obstetricians and Gynecologists shares the Food and Drug Administration’s commitment to the health and well-being of American women. We are pleased that the FDA’s action takes steps to enhance patient safety while allowing the appropriate use of power morcellation in gynecologic surgery for select women.
“As we have said in the past, we continue to believe that power morcellation has a role in gynecologic surgery. Power morcellation can make it possible for some women to undergo less-invasive laparoscopic hysterectomy or myomectomy, sparing them the longer recovery time and higher mortality rates associated with a total abdominal procedure. The FDA’s clarification of contraindications for morcellation will help to ensure that only women at low risk for an occult malignancy will undergo laparoscopic hysterectomy or myomectomy with morcellation. However, we look forward to working with the FDA to provide additional clarification regarding certain language within the contraindications that could be confusing to patients and physicians.
“Although the worsening of an occult malignancy as a result of power morcellation is, of course, tragic, we believe that an approach that combines deliberate patient selection criteria with robust informed consent will help protect women from a negative outcome, while maintaining access to morcellation for women who would benefit from it.
“Moving forward, ACOG welcomes the collection of meaningful new data that will help provide for the safe and effective use of power morcellation in the future, and we plan to continue providing the agency with input on the appropriate role of power morcellation in gynecologic surgery.” Read more from ACOG.
AAGL Position Statement – Power Morcellation
It is the opinion of the AAGL that all existing methods of tissue extraction have benefits and risks, which must be balanced. At this time, we do not believe there is a single method that can protect all patients; therefore, all current methods of tissue extraction should remain available. We believe that an understanding of the issues reviewed in this document will allow surgeons and hospitals to make the most appropriate, informed choices regarding utilization of tissue extraction in individual patients undergoing uterine surgery. Read more from AAGL.
SGO Position Statement – Power Morcellation
Uterine morcellation is commonly performed intracorporeally by gynecologists to remove the uterus through small incisions. Most commonly, morcellation is performed to reduce the size of an enlarged uterus so that it may be removed through small laparoscopic incisions or through the vagina, thus minimizing the morbidity of a larger “open” incision. However, power morcellation or other techniques that cut up the uterus in the abdomen have the potential to disseminate an otherwise contained malignancy throughout the abdominal cavity. For this reason, the Society of Gynecologic Oncology (SGO) asserts that it is generally contraindicated in the presence of documented or highly suspected malignancy, and may be inadvisable in premalignant conditions or risk-reducing surgery.
Patients being considered for minimally invasive surgery performed by laparoscopic or robotic techniques who might require intracorporeal morcellation should be appropriately evaluated for the possibility of coexisting uterine or cervical malignancy. Other options to intracorporeal morcellation include removing the uterus through a mini-laparotomy or morcellating the uterus inside a laparoscopic bag.
Uterine leiomyomas are a common indication for power morcellation. Fewer than one out of 1000 women who undergo hysterectomy for leiomyomas will have an underlying malignancy. The SGO recognizes that currently there is no reliable method to differentiate benign from malignant leiomyomas (leiomyosarcomas or endometrial stromal sarcomas) before they are removed. Furthermore, these diseases offer an extremely poor prognosis even when specimens are removed intact.
Patients and doctors should communicate about the risks, benefits and alternatives of all procedures so that a patient is able to make an informed and voluntary decision about accepting or declining medical care (ACOG Committee Opinion 439 Informed Consent). Read more from SGO.