title: Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation.
abstract: OBJECTIVE
  The purpose of this study was to describe the incidence and risk factors for uterine sarcomas and parasitic myomas at the time of power morcellation.
  
  
  METHODS
  We performed a retrospective review of 3523 women who underwent laparoscopic hysterectomy from 2001-2012. Univariate analyses were used for the morcellation cases to identify potential risk factors. Multivariable logistic regression was performed.
  
  
  RESULTS
  Nine hundred forty-one patients underwent power morcellation at the time of hysterectomy; 10 of 941 patients (1.1%) were diagnosed subsequently with uterine sarcomas or parasitic myomas. The overall incidence of uterine sarcoma was 6 of 941 (0.6%), with a median age of 47 years (range, 41-52 years). There was no association among any of the factors analyzed and uterine sarcoma. Three of 6 patients had sarcoma diagnosed on initial pathologic evaluation of the morcellated specimen; 3 patients had delayed diagnosis of sarcoma with benign disease at the time of the initial procedure (median time to second evaluation, 6 years). For parasitic myomas (n=4), the median age was 35 years (range, 32-40 years), and the median time to second evaluation was 5 years. On multivariate analysis, age<40 years (odds ratio, 26; 95% confidence interval, 2.7015-261.9; P≤.01) was associated with higher risk of the development of parasitic myomas.
  
  
  CONCLUSIONS
  Uterine sarcoma was found in 0.6% of patients who underwent power morcellation but was not found to be associated significantly with any preoperative factors. All 6 cases were noted to have apparent fibroid tumors as an indication for their hysterectomy. Age<40 years was a risk factor for parasitic myomas after power morcellation. Patients should be counseled about these complications before power morcellation.
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA. Electronic address: Jasmine.X.Tan-Kim@kp.org.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Tan-Kim
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hartzell
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
authors.forename: Caryl S
authors.initials: CS
authors.lastname: Reinsch
authors.affiliation: Department of Obstetrics and Gynecology, St. Joseph Hospital, Orange, CA.
authors.forename: Cristina H
authors.initials: CH
authors.lastname: O'Day
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
authors.forename: John S
authors.initials: JS
authors.lastname: Kennedy
authors.affiliation: Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Menefee
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Kaiser Permanente San Diego, San Diego, CA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Harrison
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012509:Sarcoma / Q000473:pathology*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: laparoscopic hysterectomy; parasitic myomas; power morcellation; uterine sarcoma