title: Risk, risk reduction and management of occult malignancy diagnosed after uterine morcellation: a commentary.
abstract: Minimally invasive surgical techniques compared with laparotomy offer the advantages of less intraoperative blood loss, shorter hospitalization, fewer wound complications and faster return to baseline activity for both hysterectomy and myomectomy. While morcellation allows for the laparoscopic removal of large specimens, it may result in intraperitoneal dissemination of benign disease or upstaging of occult malignancy leading to compromised survival. There has been heightened scrutiny over appropriate patient selection and preoperative assessment in light of recent warnings against power morcellation issued by the US FDA. This commentary therefore summarizes the magnitude of such risks associated with uterine morcellation, current national regulatory statements and potential merits of risk-reducing approaches such as contained morcellation. The importance of patient counseling is underscored.
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lynam
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Young
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.|Center of Excellence in Minimally Invasive Gynecology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Vadim
authors.initials: V
authors.lastname: Morozov
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.|Division of Gynecologic Oncology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Rao
authors.affiliation: Department of Obstetrics, Gynecology, & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD 21201, USA.|Division of Gynecologic Oncology, Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Roque
mesh_terms: D019468:Disease Management; D005260:Female; D006801:Humans; D000069577:Morcellation / Q000009:adverse effects* / Q000379:methods; D009366:Neoplasm Seeding; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D018579:Patient Selection; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: carcinosarcoma; disseminated leiomyomatosis; endometrial stromal sarcoma; laparoscopy; leiomyoma; leiomyosarcoma; morcellation