After a personal experience with morcellation-spread cancer, two doctors from Boston have become vociferous advocates for morcellation surgery safety.

Doctors Amy R. and her husband Hooman N. had had six children when Amy underwent what should have been a routine hysterectomy for uterine fibroids in 2013.

Amy, an anesthesiologist, says that in preparing for her surgery, she expressed a preference for open abdominal surgery rather than laparoscopic surgery using a power morcellator.

She was told by a colleague that no surgeon would do what she was requesting, since there was no known reason not to do the surgery laparoscopically, and no outstanding issues of morcellation surgery safety.

Prior to surgery, Amy underwent thorough testing for cancerous tissue, including biopsies and imaging studies, none of which revealed any cancer. Amy then underwent her hysterectomy laparoscopically, the doctors using a power morcellator.

Days after the surgery, her doctor told her the pathology report revealed a leiomyosarcoma in her uterus. Sarcomas are a type of cancer that can grow wherever they land inside the body, so the standard way to remove a sarcoma surgically is to remove it in a single piece.

However, in Amy’s case, use of a power morcellator had cut up the cancerous tissue and spread it throughout her abdomen.

Before the surgery, Amy’s cancer was likely at stage 1, with a 60 percent five-year survival rate. After she underwent the hysterectomy using a power morcellator, her cancer advanced to stage 4 with much lower odds of survival.

Seeking Better Standards for Morcellation Surgery Safety

Now, Amy and her husband  fight to get power morcellators taken out of use in gynecological surgery. They say that using a power morcellator presents an unacceptable risk of upstaging cancer in practically all cases.

The couple’s efforts were initially met with resistance from the medical community. They were told that their concerns about morcellation surgery safety were unfounded when considered in the big picture.

The risk of cancer upstaging due to power morcellation was too rare to warrant eliminating the technique entirely, they were told.

The American Association of Gynecologic Laparoscopists came out with a formal statement in opposition to putting limits on morcellation.

But gradually, new information came out that supported the couple’s efforts. For example, leiomyosarcoma turns out to be not as rare as it was thought to be.

Amy had been previously told the cancer affected one woman in 10,000. But that figure was based on research of the general population.

The frequency of leiomyosarcoma and similar cancers is actually much higher – one in 415, by one measure – for women with symptomatic fibroids. And women with symptomatic fibroids are exactly who might be candidates for surgery using morcellation.

Amy and Hooman’s efforts yielded fruit when several institutions began to restrict open morcellation, allowing surgeons to continue the practice by using a bag to catch the morcellated, or cut up, tissue.

The couple continues to press for complete elimination of morcellators, however. They say the risk that the bags could break does not allow for adequate morcellation surgery safety.

The FDA has since issued a formal warning stating that morcellation is not a safe choice for most patients undergoing surgery for uterine fibroids. By the FDA’s own measure, as many as one in 350 women undergoing surgery for fibroids have an unsuspected cancer.