Tissue morcellation is by no means a new concept in laparoscopic surgery, but recent concerns regarding open power morcellation in gynecologic procedures have called the practice into question.

What Are Power Morcellators?

Gynecologists use power morcellators when they perform laproscopic procedures, such as a hysterectomy or a myomectomy, in which they remove uterine fibroids. These instruments have rotating blades that break large tissue masses into small fragments. Broken down tissues are then vacuumed out of the body through a small incision.

Risks Associated With Power Morcellation

The inherent risk of laproscopic power morcellation is the dissemination of the broken-up tissue. Benign tissue can become implanted on abdominal structures and organs, resulting in conditions such as fibroids, endometriosis, and adenomyosis, potentially requiring further surgery.

However, while doctors can diagnose most forms of cancer before an operation, a rare form, called leiomyosarcoma or uterine sarcoma, may mimic the appearance of benign uterine fibroids in medical imaging and is often undetectable in preoperative testing.

Frequently, this aggressive cancer is diagnosed post-surgery after tissues are examined by a pathologist. Unfortunately, if a power morcellator was used to extract that tissue, the hidden cancer may have been spread, becoming metastatic leiomyosarcoma, which significantly worsens the patient’s likelihood of long-term survival.

The Controversy Over Power Morcellation

In 2012, a study published in PLOS ONE may have sparked the current power morcellation controversy. The study suggested that the rate of undetected leiomyosarcomas among women undergoing power morcellation for fibroids was nine-fold higher than commonly believed, suggesting a higher risk of spreading undetected cancer than previously suspected.

In 2013, the issue became highly publicized when the The Wall Street Journal published a story about Dr. Amy Reed, an anesthesiologist and mother of six. Dr. Reed was found to have occult leiomyosarcoma while undergoing a minimally invasive hysterectomy using morcellation for fibroids, a procedure that may have worsened her prognosis.

Since then, Dr. Reed’s husband, cardiothoracic surgeon Dr. Hooman Noorchashm, has become a vocal advocate for banning morcellation.

After that, the power morcellation controversy gained momentum. Later in the year, the Society of Gynecologic Oncology published a statement saying that women with premalignant conditions should not undergo morcellation and that physicians need to thoroughly inform patients of the risks involved.

FDA Safety Concerns

The U.S. Food and Drug Administration (FDA) issued a safety warning in April discouraging doctors from using laparoscopic power morcellators to remove uterine fibroids because of the risk of spreading undiagnosed cancer throughout the abdominal cavity. The devices also spread benign tissues throughout the abdominal cavity, where they can grow on other organs, causing pain, bowel obstruction and infection.

Power Morcellation Cancer Lawsuits

A growing number of power morcellator cancer lawsuits stem from the use of laparoscopic power morcellators in hysterectomies and other gynecological surgeries.

However, some doctors are still performing hysterectomies and uterine fibroid removals via uterine morcellation, despite the FDA warning.

According to a report published by The Wall Street Journal, these gynecologists believe that the FDA is interfering with patient care, and that the agency is overstating the dangers associated with power morcellators.