title: Safety of Manual Morcellation After Vaginal or Laparoscopic-assisted Vaginal Hysterectomy.
abstract: STUDY
  
  
  
  To determine the safety of manual vaginal morcellation by evaluating the rates of incidental uterine malignancy and manual vaginal morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy.
  
  
  
  Retrospective analysis (Canadian Task Force classification II-2).
  
  
  
  University of Texas Southwestern Medical Center, Dallas, TX.
  
  
  
  Women (n = 1,629) undergoing vaginal or laparoscopic-assisted vaginal hysterectomy.
  
  
  
  Vaginal hysterectomy (n = 1,091) or laparoscopic-assisted vaginal hysterectomy (n = 538) with and without scalpel morcellation.
  
  
  
  The number of uterine malignancies, rate of vaginal morcellation, surgical indications, pathology diagnoses, and uterine weights were evaluated. Chi-square analysis was used to compare categoric data, and analysis of variance was used to compare uterine weights. There were no cases of leiomyosarcomas. There were 2 other sarcomas, 4 smooth muscle tumors of uncertain malignant potential, and 8 endometrial adenocarcinomas. The vaginal morcellation rate was 19.4%, but no malignancy was morcellated. Myomas were more common preoperatively and histologically in morcellated specimens. Mean (± standard deviation) uterine weights for morcellated versus nonmorcellated laparoscopic-assisted vaginal hysterectomy specimens were 285.5 ± 159.3 versus 140.1 ± 83.6 g (p < .001), respectively, and 199.9 ± 92.8 versus 111.9 ± 61.4 (p < .001), respectively, for vaginal hysterectomy.
  
  
  
  Vaginal manual morcellation is safe with a low risk of incidental malignancy. Variables that influence the decision for the vaginal approach may also affect malignancy risk and morcellation decisions. Thus, all patients undergoing vaginal or laparoscopic-assisted vaginal hysterectomy should be counseled regarding incidental malignancy, risk of morcellation, and alternatives for intact specimen removal.
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Sunil.Balgobin@UTSouthwestern.edu.
authors.forename: Sunil
authors.initials: S
authors.lastname: Balgobin
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Maldonado
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Santa Clara, Santa Clara, CA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Chin
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Schaffer
authors.affiliation: Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Cherine A
authors.initials: CA
authors.lastname: Hamid
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002277:Carcinoma / Q000453:epidemiology; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D033162:Incidental Findings; D010535:Laparoscopy; D007889:Leiomyoma / Q000453:epidemiology; D008875:Middle Aged; D000069577:Morcellation / Q000009:adverse effects* / Q000379:methods; D009214:Myoma / Q000453:epidemiology; D012189:Retrospective Studies; D012509:Sarcoma / Q000453:epidemiology; D018235:Smooth Muscle Tumor / Q000453:epidemiology*; D013781:Texas / Q000453:epidemiology; D014549:Urinary Incontinence / Q000209:etiology; D014592:Uterine Hemorrhage / Q000209:etiology; D014594:Uterine Neoplasms / Q000453:epidemiology*
keywords: Incidental malignancy; Morcellation; Vaginal hysterectomy