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Researchers Suggest Morcellation in a Bag May Reduce Cancer Risks

female patient with doctorA new study on power morcellation was recently accepted for publication by the American Journal of Obstetrics and Gynecology. The researchers took a close look at the risks of power morcellation compared with the potential benefits of laparoscopic surgery over open surgery.

They also hinted that a recently touted technique, known as morcellation in a bag, may merit further study.

Dangers of power morcellation

Power morcellation is a surgical technique that, until recently, had been widely used in surgeries of women’s reproductive systems. These include hysterectomies and myomectomies (to remove the uterus and uterine fibroids). To perform a laparoscopic surgery, the surgeon can make a series of incisions, rather than the one large incision required for open surgery. Through the incisions, the surgeon inserts a laparoscope and other tiny surgical instruments. One of the tools the surgeon can use is a power morcellator, which tears apart the uterine fibroids, uterus, or other structures. When these structures are in tiny pieces, the surgeon is able to remove them from the small incisions.

However, some women who undergo these surgeries have previously undetected reproductive cancers. Power morcellation may inadvertently propel cancerous cells far beyond their point of origin, thus rapidly advancing the stage of the disease and worsening the prognosis.

Latest study to examine risks

“Prevalence of Unexpected Leiomyosarcoma at Myomectomy: A Descriptive Study” was conducted by a team of Italian researchers. According to the study, the FDA states that one out of every 498 myomectomy procedures may cause the spread of leiomyosarcomas. However, the researchers pointed out that leiomyosarcomas are most often diagnosed among women who are over the age of 50. They proposed the separate evaluation of populations based on age.

The researchers evaluated 15 years of data, which amounted to 2,356 myomectomies performed in women with a mean age of 39 years. They concluded that the risk of unexpected leiomyosarcoma was less than one in every 2,000 cases. Although this figure is far lower than the FDA’s data, the researchers conceded that this could be due to the younger population of their study.

Morcellation in a bag

Among the researchers’ conclusions, they noted that, “Myoma morcellation in a bag could theoretically limit intraperitoneal dissemination of malignant cells, but the efficacy of such containment devices has yet to be proven.”
Morcellation in a bag refers to the use of power morcellation within a carefully controlled, enclosed environment. Using this technique, the surgeon can place the uterine tumor in a sterile bag before using a power morcellator on the tissue inside of the bag. Then, both the bag and the morcellated tissue can be removed.

While this technique sounds promising, it does have its limitations. If the uterine fibroid is particularly large, the surgical port incision will need to be enlarged. Additionally, as these researchers pointed out, there is a lack of evidence regarding the safety of this technique. It is still possible that cancer cells can be disseminated beyond their point of origin. Other healthcare experts have suggested expanding the use of sophisticated imaging studies prior to surgeries to promote the early detection of leiomyosarcomas.

  1. American Journal of Obstetrics and Gynecology, Prevalence of Unexpected Leiomyosarcoma at Myomectomy: A Descriptive Study,
  2. OBG Management, Benefits and pitfalls of open power morcellation of uterine fibroids,