title: Updates in uterine fibroid tissue extraction.
abstract: Safety concerns regarding morcellation of presumed benign fibroid disease have led to an increase in recent research activity on this topic, as well as advances in surgical technique.
  
  
  
  The prevalence of occult leiomyosarcoma is debated; however, estimates from a robust meta-analysis suggest it may be in the range of 1 case per 1960-8300 fibroid surgeries. Advancing age is an important clinical risk factor for occult malignancy. The impact of tumor morcellation may vary by mode of tissue removal, though tissue fragmentation is consistently associated with poorer outcomes. Decision and cost analyses continue to support laparoscopic hysterectomy as a low-morbidity and cost-effective approach. The increased scrutiny on fibroid procedures in the past few years may lead to changes in surgical approach; however, alternative tissue extraction options are evolving, including incorporation of contained morcellation.
  
  
  
  Although the incidence of occult leiomyosarcoma is low, outcomes are poor and may be worsened by morcellation. By addressing risk factors for malignancy and incorporating evolving surgical techniques into practice, gynecologists can continue to offer patients a minimally invasive approach for fibroid management.
authors.affiliation: aBrigham and Women's Hospital, Boston, Massachusetts bCedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hariton
authors.forename: Yalda
authors.initials: Y
authors.lastname: Afshar
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Siedhoff
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology / Q000601:surgery*; D007890:Leiomyosarcoma / Q000473:pathology / Q000517:prevention & control; D000069577:Morcellation / Q000009:adverse effects / Q000379:methods; D018579:Patient Selection; D012307:Risk Factors; D014020:Tissue Extracts; D014594:Uterine Neoplasms / Q000473:pathology / Q000517:prevention & control
chemical_list: D014020:Tissue Extracts