ACOG Committee Opinion No. 770: Uterine Morcellation for Presumed Leiomyomas

Obstetrics and Gynecology

Abstract

Morcellation is a surgical technique used to reduce the size of the uterus or myomas by creating smaller pieces to allow the tissue to be removed through small incisions or with laparoscopic instruments. Open (uncontained) morcellation of the uterus and myomas has been scrutinized because of the possible spread of an unsuspected leiomyosarcoma while using a power morcellator during a hysterectomy or myomectomy for presumed symptomatic uterine leiomyomas. Before considering open morcellation of the uterus, a woman should be evaluated to determine if she is at increased risk of malignancy of the uterine corpus. Morcellation of a malignancy is contraindicated, and women should be evaluated preoperatively to identify malignancy. However, leiomyosarcoma cannot be reliably diagnosed preoperatively; thus, there is a risk that a woman with a presumed leiomyoma may have a malignancy that may be spread through morcellation, leading to a potentially worsened prognosis. Although an abdominal hysterectomy or myomectomy may reduce the chance of spreading cancer cells in women with undiagnosed leiomyosarcoma, it is associated with increased morbidity when compared with minimally invasive approaches. The obstetrician-gynecologist and patient s...Continue Reading

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Citations

Sep 14, 2019·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Xiao XuVrunda B Desai
Dec 17, 2019·Journal of Comparative Effectiveness Research·Ehren Schuttringer, Trinidad Beleche
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Jul 13, 2021·Frontiers in Medicine·Giovanni MonniFederica Murgia
Aug 30, 2021·Women's Health Issues : Official Publication of the Jacobs Institute of Women's Health·Lisa A BraunCandy Wilson

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