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Options on fibroid morcellation: a literature review

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Abstract In laparoscopy, specimens have to be removed from the abdominal cavity. If the trocar opening or the vaginal outlet is insufficient to pass the specimen, the specimen needs to be reduced. The power morcellator is an instrument with a fast rotating cylindrical knife which aims to divide the tissue into smaller pieces or fragments. The Food and Drug Admin-istration (FDA) issued a press release in April 2014 that experienced ESGEmembers requested to chair an action group to address distinct clinical questions. Clinical questions were formulatedwith regards to the sarcoma risk in presumed uterine fibroids, diagnosis of sarcoma, complications of morcellation and future research. A literature review on the different subjects was conducted, systematic if appropriate and feasible. It was concluded that the true prevalence of uterine sarcoma in pre-sumed fibroids is not known given the wide range of preva-lences (0.45–0.014 %) from meta-analyses mainly based onretrospective trials. Age and certain imaging characteristics such as‘lacunes’suggesting necrosis and increased central vas cularisation of the tumour are associated with a higher risk o uterine sarcoma, although the risks remain low. There is not enough evidence to estimate this risk in individual patients. Complications of morcellation are rare. Reported are direct morcellation injuries to vessels and bowel, the development of so-called parasitic fibroids requiring reintervention and the spread of sarcoma cells in the abdominal cavity, which may possibly or even likely upstaging the disease. Momentarily in-bag morcellation is investigated as it may possibly prevent morcellation complications. Because of lack of evidence, this literature reviewcannot give strong recommendations but offers only options which are condensed in a flow chart. Prospective data collection may clarify the issue on sarcoma risk in pre-sumed fibroids and technology toextract tissue laparoscopically from the abdominal cavity should be perfected

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Informasi Detail

Judul Seri

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No. Panggil

Artikel

Penerbit

USA : Springer., 2015

Deskripsi Fisik

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Bahasa

English

ISBN/ISSN

DOI 10.1007/s10397-0

Klasifikasi

NONE

Tipe Isi

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Tipe Media

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Tipe Pembawa

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Edisi

Gynecol Surg (2015) 12:3–15

Subjek

Medicine
morcellation

Info Detail Spesifik

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Pernyataan Tanggungjawab

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