title: [Current controversies regarding power morcellation and future directions].
abstract: Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.
authors.affiliation: Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France. Electronic address: yohan.kerbage@gmail.com.
authors.forename: Y
authors.initials: Y
authors.lastname: Kerbage
authors.affiliation: Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
authors.forename: H
authors.initials: H
authors.lastname: Azaïs
authors.affiliation: Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Estevez
authors.affiliation: Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
authors.forename: B
authors.initials: B
authors.lastname: Merlot
authors.affiliation: Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Collinet
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D000069577:Morcellation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D012509:Sarcoma / Q000473:pathology; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000517:prevention & control; D014599:Uterus / Q000473:pathology
keywords: Hysterectomy; Hystérectomie; Morcellement; Myomectomie; Myomectomy; Power morcellation; Sarcome utérin; Uterine sarcoma