title: Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women.
abstract: OBJECTIVE
  To evaluate the incidence of uterine leiomyosarcomas (LMSs). To identify the risk of morcellating LMS in a gynecological department that offers laparoscopic supracervical hysterectomy (LSH) and laparoscopic myomectomy as primary surgical treatments.
  
  
  METHODS
  A retrospective trial.
  
  
  METHODS
  Canadian Task Force Classification III.
  
  
  METHODS
  Norwegian university teaching hospital.
  
  
  METHODS
  Women diagnosed with uterine LMS and the total population of women who were referred for surgical treatment of uterine fibroids from January 1, 2000 to December 31, 2013.
  
  
  METHODS
  Surgical treatment of fibroids, including LSH, abdominal supracervical hysterectomy, total laparoscopic hysterectomy, total abdominal hysterectomy, laparoscopic myomectomy, and hysteroscopic resection of fibroids.
  
  
  RESULTS
  A total of 4791 women were included in this trial; 1957 laparoscopic procedures were performed, and a morcellator was used in 1846 of the procedures. Twenty-six women were diagnosed with uterine LMS specimens after surgery. The mean ± SD age of women with LMS was 61.2 ± 12.3 years, and the mean ± SD of the tumor size at time of diagnosis was 90.9 ± 45.4 mm. Of these 26 women, 6 were diagnosed with uterine LMS by endometrial biopsy before surgical treatment, and 14 women were treated by open hysterectomy and bilateral salpingo-oophorectomy due to a clinical preoperative suspicion of a malignant condition. Consequently, 6 women with uterine LMS were treated according to the protocol for anticipated benign fibroids. Five of these women underwent laparotomy due to tumor size. LSH was performed in 1 woman, and a morcellator was used for tissue extraction. The incidence of uterine LMS in the population of women referred for anticipated benign fibroids was 0.0054 (1 in 183 women). The rate of unintended morcellation of a LMS at our department between January 1, 2000 and December 31, 2013 was 0.0002 (1 in 4791 women).
  
  
  CONCLUSIONS
  The incidence of uterine LMS was comparable with the incidence reported in the literature. The risk of unintended morcellation of uterine LMS after a preoperative selection of women with fibroids appears to be very low.
authors.affiliation: Department of Gynecology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address: marit.lieng@online.no.
authors.forename: Marit
authors.initials: M
authors.lastname: Lieng
authors.affiliation: Department of Gynecology, Oslo University Hospital, Oslo, Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Berner
authors.affiliation: Department of Gynecology, Oslo University Hospital, Oslo, Norway.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Busund
mesh_terms: D000328:Adult; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy; D007889:Leiomyoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D007890:Leiomyosarcoma / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopic myomectomy; Laparoscopic supracervical hysterectomy; Leiomyosarcoma; Power morcellation; Uterine leiomyosarcoma; Uterine tissue extraction