title: Incidence of Tissue Morcellation During Surgery for Uterine Sarcoma at a Canadian Academic Centre.
abstract: OBJECTIVE
  To determine the incidence of tissue morcellation during surgery for uterine sarcoma in a Canadian tertiary academic centre.
  
  
  METHODS
  In this retrospective cohort study, the clinical charts of all women who underwent hysterectomy for uterine sarcoma at the Ottawa Hospital between April 1, 2007, and March 31, 2014, were reviewed for their clinical characteristics and details of surgical treatment.
  
  
  RESULTS
  Sixty-six cases of uterine sarcoma were identified. The mean (± SD) age of patients was 62.1 ± 10 years, and 81.8% were postmenopausal. Of the tumours, 43.9% were carcinosarcomas, 28.8% were leiomyosarcomas, 13.6% were endometrial stromal sarcomas, 6.1% were adenosarcomas, 1.5% were uterine rhabdomyosarcomas, and 6.1% were undifferentiated sarcomas. None of the surgical specimens were morcellated by laparoscopic power morcellation, and 61/66 (92.4%) of patients had their surgery performed by a gynaecologic oncologist. In the remaining five women whose surgery was performed by a general gynaecologist (4 with leiomyosarcomas and 1 with undifferentiated uterine sarcoma), two surgical specimens were morcellated manually using a scalpel during the removal of presumed fibroids at hysterectomy performed by midline laparotomy. The first of these was a case performed as an emergency because of acute pelvic symptoms secondary to leiomyosarcoma, and the second case had a solitary leiomyosarcoma among multiple benign leiomyomata.
  
  
  CONCLUSIONS
  Uterine sarcomas are uncommon, and morcellation is rarely performed but may nevertheless be performed in the surgical management of presumed fibroids. Further studies and the establishment of a national registry are needed to better quantify the risk of morcellation, to characterize clinical risk factors, and to provide surgical alternatives for women undergoing uterine surgery.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa ON; The Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa ON; The Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Laura
authors.initials: L
authors.lastname: Hopkins
authors.affiliation: The Ottawa Hospital Research Institute, Ottawa ON; Faculty of Medicine, University of Ottawa, Ottawa ON.
authors.forename: Bianca
authors.initials: B
authors.lastname: Firth
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa ON; The Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Julia
authors.initials: J
authors.lastname: Boucher
authors.affiliation: Department of Obstetrics and Gynaecology, University of Ottawa, Ottawa ON; The Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Sukhbir S
authors.initials: SS
authors.lastname: Singh
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: fibroid; hysterectomy; morcellation; uterine sarcoma