title: Medical Device Safety and Surgical Dissemination of Unrecognized Uterine Malignancy: Morcellation in Minimally Invasive Gynecologic Surgery.
abstract: There is a risk of dissemination of uterine malignancies during minimally invasive hysterectomies when morcellation is used. Although the technique of uterine power morcellation allows timely removal of large benign tumors through small laparoscopic incisions, there are concerns about iatrogenic spread of cancers and reduced survival for women with preoperatively unrecognized malignancies. This review examines the literature on intraperitoneal spread and implantation of mechanically disrupted malignant tissue, discusses the current diagnostic tools for preoperative assessment of uterine tumors, and summarizes the current recommendations of the Society of Gynecologic Oncologists, the American College of Obstetricians and Gynecologists, and the American Association of Gynecologic Laparoscopists. Recommendations include informed consent of the risk of disseminating an otherwise contained malignancy, appropriate preoperative evaluation for malignancy, and development of alternatives to intracorporeal morcellation.
  
  
  CONCLUSIONS
  Preoperative assessment of uterine masses or abnormal uterine bleeding must include understanding of the limitations of an endometrial biopsy and imaging studies to evaluate the possibility of a uterine malignancy. Minimally invasive surgery using morcellation of benign uterine growths is well established and safe; however, alternative surgical techniques to morcellation must be considered when the malignant potential of a uterine mass is uncertain. Morcellation carries the risk of widespread peritoneal seeding of an unrecognized uterine malignancy. Gynecologic surgeons must weigh the unlikely occurrence of disseminating an undiagnosed uterine sarcoma with the much more common surgical risks of abdominal surgery.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA trhall@mgh.harvard.edu.
authors.forename: Tracilyn
authors.initials: T
authors.lastname: Hall
authors.affiliation: Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Susanna I
authors.initials: SI
authors.lastname: Lee
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D000069577:Morcellation / Q000009:adverse effects*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Morcellation; Peritoneal dissemination; Power morcellation; Uterine sarcoma