title: Unanticipated uterine pathologic finding after morcellation during robotic-assisted supracervical hysterectomy and cervicosacropexy for uterine prolapse.
abstract: BACKGROUND
  Identification of occult malignancy after intra-abdominal morcellation at the time of robotic-assisted supracervical hysterectomy and cervicosacropexy for uterine prolapse may lead to challenging postoperative management and leads one to question the need for preoperative evaluation.
  
  
  METHODS
  We present 2 cases of occult endometrial carcinoma after robotic-assisted supracervical hysterectomy and cervicosacropexy with intra-abdominal uterine morcellation from January 2008 to December 2010. A total of 63 patients underwent the stated surgical procedure with 2 patients (3.17%) found to have abnormal uterine pathologic finding with International Federation of Gynecology and Obstetrics grade 1 endometrial adenocarcinoma. Both cases occurred in asymptomatic postmenopausal patients without risk factors for endometrial cancer, including no history of postmenopausal bleeding or hormone replacement therapy. Owing to intraoperative uterine morcellation and cervical retention, appropriate postoperative management was controversial and problematic. Each patient was referred to gynecologic oncology. To date, both patients are without evidence of residual disease.
  
  
  CONCLUSIONS
  Owing to the risk of occult uterine pathologic finding and complicated postoperative management, preoperative endometrial assessment should be considered on all postmenopausal patients undergoing intra-abdominal uterine morcellation, regardless of risk factors.
authors.affiliation: From the *Department of Obstetrics and Gynecology, Virginia Commonwealth University Health System, and †Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina, Chapel Hill, NC.
authors.forename: Audra Jolyn
authors.initials: AJ
authors.lastname: Hill
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Carroll
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Matthews
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000175:diagnosis*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D033162:Incidental Findings; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012307:Risk Factors; D012371:Robotics