title: Electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures.
abstract: OBJECTIVE
  To identify, collate, and summarize the most common causes and pathologies of electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures.
  
  
  METHODS
  A systematic review of published medical literature from January 1990 to February 2014 reporting morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures involving the use of intracorporeal electric tissue morcellators. Publications were included in this review if patients underwent a second surgical procedure because of the onset of new clinical symptoms after a primary surgical procedure that involved intracorporeal morcellation or if histopathology of the morcellated surgical specimen revealed malignancy (Canadian Task Force classification II-3).
  
  
  METHODS
  All case reports and case series were reported from community and academic hospitals in the United States and the rest of the world.
  
  
  METHODS
  We identified 66 patients from 32 publications.
  
  
  METHODS
  Reoperation after laparoscopic myomectomy and nonmyomectomy procedures involving intracorporeal electric tissue morcellation.
  
  
  RESULTS
  For patients who presented with new clinical symptoms requiring reoperation, we recorded the follow-up period, nature and duration of the new symptoms, details of the second surgical procedure, intraoperative findings during the second surgical procedure, and the final histopathologic diagnosis. When histopathology of the morcellated specimen revealed malignancy, we recorded the specific type of malignancy, the corresponding surgical treatment that the patient underwent, and the follow-up period. Percentages and 95% confidence intervals were calculated for all categoric variables. Twenty-four (36.4%) patients underwent laparoscopic myomectomies, of which 19 (79.2%) and 5 (20.8%) patients required a second surgical procedure because of new clinical symptoms and the diagnosis of malignancy in the morcellated surgical specimen, respectively. Forty-two (63.6%) patients underwent laparoscopic hysterectomies; of these, 25 (59.5%) patients required a second surgical procedure because of the onset of new clinical symptoms, whereas the remaining 17 (40.5%) patients underwent a second surgical procedure because of the diagnosis of malignancy in the morcellated surgical specimen. The most common benign pathology was parasitic leiomyomata (22 patients, 33.3%). The most common malignant pathology was leiomyosarcoma (16 patients, 24.2%).
  
  
  CONCLUSIONS
  Dispersion of tissue fragments into the peritoneal cavity at the time of morcellation continues to be a concern. It was previously thought that morcellated tissue fragments are resorbed by the peritoneal cavity; however, there is some evidence highlighting the long-term sequelae related to the growth and propagation of these dispersed tissue fragments in the form of parasitic leiomyomata, iatrogenic endometriosis, and cancer progression. Yet, the majority of laparoscopic myomectomy and nonmyomectomy procedures involving the use of intracorporeal electric tissue morcellators are uncomplicated, and institutions having no women with endometriosis or cancer are very unlikely to report surgical outcomes of uneventful electric morcellation. Thus, prospective studies are still required to validate the role of electric intracorporeal tissue morcellation in the pathogenesis of parasitic leiomyomata, iatrogenic endometriosis, and cancer progression.
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania. Electronic address: nigelpereira@gmail.com.
authors.forename: Nigel
authors.initials: N
authors.lastname: Pereira
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Tommy R
authors.initials: TR
authors.lastname: Buchanan
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Kayla M
authors.initials: KM
authors.lastname: Wishall
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Division of General Gynecology, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania.
authors.forename: Irene
authors.initials: I
authors.lastname: Grias
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Division of Gynecologic Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Richard
authors.affiliation: Department of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, Pennsylvania; Division of Minimally Invasive Gynecologic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Carl R
authors.initials: CR
authors.lastname: Della Badia
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery; D008499:Medical Records; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010529:Peritoneal Cavity / Q000473:pathology; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D020379:Risk Adjustment; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery
keywords: Complications; Hysterectomy; Laparoscopy; Morcellation; Myomectomy; Reoperation