title: Disseminated leiomyoma cells can be identified following conventional myomectomy.
abstract: Uncontained morcellation of leiomyomas during laparoscopic surgery has recently been discouraged, as undetected malignant tumours, namely leiomyosarcomas, could be fragmented which may result in upstaged disease. However, enucleating leiomyomas per se may be inappropriate from an oncological perspective because complete, radical resection of malignant tumours to prevent further tumour growth or recurrence is not achieved. Thus, the aim of this study was to determine whether spillage of leiomyoma cells occurs during laparotomic myomectomy.
  
  
  
  Observational study.
  
  
  
  Tertiary academic centre in the Netherlands.
  
  
  
  Women undergoing laparotomic myomectomy were included in the study.
  
  
  
  Peritoneal abdominal washings were obtained on two occasions during the myomectomy procedure; the first one immediately after opening the abdomen and the second one after resection of the leiomyoma(s). Cytological evaluation of the fluids was performed.
  
  
  
  The presence of leiomyoma cells in any of the washings.
  
  
  
  Five patients were included in this pilot study. All first washings were negative for leiomyoma cells. However, cytology positive for the presence of leiomyoma cells was found in three of the five second, post-myomectomy washings.
  
  
  
  Tissue spillage from leiomyoma(s) occurs during conventional open myomectomy. The clinical relevance of tissue dissemination after myomectomy is unclear but it cannot be excluded that this may negatively affect the patient's outcome if there is malignant change within the enucleated leiomyoma(s). Therefore, it is questionable whether morcellation in specially designed containment bags after laparoscopic myomectomy, guarantees any additional oncological safety.
  
  
  
  Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s).
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: E M
authors.initials: EM
authors.lastname: Sandberg
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van den Haak
authors.affiliation: Department of Pathology, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Bosse
authors.affiliation: Department of Gynaecology, Leiden University Medical Centre, Leiden, the Netherlands.|Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery*; D009366:Neoplasm Seeding; D009360:Neoplastic Cells, Circulating; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery*
keywords: Laparoscopic myomectomy; morcellation; tissue dissemination