Non-malignant Sequelae after Unconfined Power Morcellation

Abstract

Study objective: To identify the incidence of repeat surgery and subsequent findings after the performance of unconfined uterine power morcellation.

Design: A retrospective descriptive study (Canadian Task Force classification II-2).

Setting: Southern California Kaiser Permanente Medical Centers.

Patients: Women (N = 5154) who underwent laparoscopic supracervical hysterectomy with unconfined power morcellation.

Measurements and main results: Of the 5154 cases, 279 (5.41%) underwent subsequent reoperation with a median of 24 months after index surgery. The most common clinical complaint leading to laparoscopic supracervical hysterectomy was symptomatic leiomyoma (n = 135, 48.4%) and abnormal uterine bleeding (n = 94, 33.7%). The most common indication for reoperation was a symptomatic adnexal mass (n = 87, 31.2%) followed by pelvic pain (n = 83, 29.7%). The majority (n = 128, 60.4%) of subsequent non-urogynecologic-related reoperations resulted in benign pathology. Endometriosis was the primary pathologic diagnosis in 65 of 279 (23.3%) of the reoperative cases; this was not previously documented in 86% (n = 57/65) of these cases. The overall frequency of subsequent pathology was endometriosis (65/5154, 1.26%), disseminated leiomyomatosis (18/5154, 0.35%), and new malignancy (11/5154, 0.21%).

Conclusion: Morcellation of nonmalignant tissue is not without consequence. Pathology confirmed endometriosis was documented for the first time in 20.4% of patients who underwent a second surgery. This finding raises the suspicion that morcellation and dispersion of the uterine specimen may be associated in the development of endometriosis.

Keywords: Abnormal uterine bleeding; Endometriosis; Laparoscopy; Parasitic leiomyoma.