title: Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study.
abstract: BACKGROUND
  Over the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation.
  
  
  OBJECTIVE
  The aim of our study was to identify the complication rate of power morcellation at our institution.
  
  
  METHODS
  We performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded.
  
  
  RESULTS
  A total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall complication rate of laparoscopic supracervical hysterectomy was 4.3% (n=8). Need for reoperation after laparoscopic supracervical hysterectomy was necessary in 7 patients (3.8%), with cervical amputation being the most common type of reoperation (n=5). In the laparoscopic-assisted vaginal hysterectomy group there were significantly more adhesiolysis performed (n=4). Parasitic myomas were discovered in 1 patient two years after morcellation (0.5%).
  
  
  CONCLUSIONS
  Our study showed no injuries directly related to morcellation. There were no unexpected malignancies morcellated and only one case of parasitic myomas (0.5%).
authors.affiliation: Department of Gynecology, Eindhoven, Catharina Ziekenhuis, The Netherlands. Electronic address: roos.smits@catharinaziekenhuis.nl.
authors.forename: Roos M
authors.initials: RM
authors.lastname: Smits
authors.affiliation: Department of Gynecology, Nijmegen, Canisius-Wilhelmina Ziekenhuis, The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: De Kruif
authors.affiliation: Department of Gynecology, Nijmegen, Canisius-Wilhelmina Ziekenhuis, The Netherlands.
authors.forename: Cathelijne F
authors.initials: CF
authors.lastname: Van Heteren
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D000069577:Morcellation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Complication; Laparoscopic supracervical hysterectomy; Laparoscopic-assisted vaginal hysterectomy; Morcellation; Parasitic myomas