A new study suggests that power morcellation might still be a reasonably safe method of uterine fibroid surgery, but only for younger patients.

The study addresses the risk that using power morcellation for hysterectomy or uterine fibroid surgery may inadvertently spread cancer that went undetected prior to the surgery.

Power morcellators are used in laparoscopic surgery to cut tissue into smaller pieces that can be easily removed. The concern is that power morcellation may also shred cancerous tissue and spread it elsewhere in the abdomen.

Doctors are most concerned that this can happen in cases of undetected leiomyosarcoma, a cancer that is difficult to detect prior to surgery and which also resembles non-cancerous fibroids. This risk of morcellation cancer has received increasing attention in recent years, drawing some decisive responses from the medical community as well as a growing number of morcellation cancer lawsuits.

The study was recently published in the American Journal of Obstetrics and Gynecology. It reviewed the results in 2,356 myomectomies, or surgeries performed to remove uterine fibroids.

The researchers found that unexpected leiomyosarcoma occurred less frequently in patients undergoing myomectomy than in those undergoing hysterectomy. In the myomectomy patients, cancer or potential cancer occurred no more frequently than in 1/1000 cases. This was lower than an estimate of 1/498 published by the FDA.

However, the FDA’s numbers included hysterectomy patients. The researchers commented that hysterectomy patients should be considered separately because they tend to be older and thus have a greater risk of unexpected cancer.

The researchers also noted that banning power morcellators outright could result in an increase in morbidity among younger patients. Since younger patients have a much lower risk of leiomyosarcoma, a less invasive procedure like power morcellation might actually be safer for them than open surgery.

The study’s conclusions echo a warning issued by the FDA in November 2014, advising health care providers not to use power morcellation on patients who are peri- or post-menopausal. The FDA also notes such women constitute the majority of women who undergo hysterectomy or myomectomy.

This study is published during a transitional period in the way the medical community uses power morcellator technology. Some health care providers have ceased to use the device altogether due to safety concerns.

In November 2014, HCA Holdings Inc., the operator of 280 different hospitals in the U.S. and England, voluntarily banned the use of the device. Tenet Healthcare Corp. still uses the devices but restricts their use to patients under age 40.

Some manufacturers have also stopped selling power morcellators outright. Johnson & Johnson’s subsidiary Ethicon, the largest maker of power morcellators, first suspended their sales in April 2014 and then stopped sales altogether in July 2014.

On the civil litigation side, manufacturers began to face morcellation cancer lawsuits in small numbers about a year ago, though that number is expected to grow substantially.

One estimate says that Johnson & Johnson alone may face over 5,000 claims related to morcellation cancer. Other, smaller companies that also make power morcellators include Karl Storz GmbH & Co., Blue Endo, LiNA Medical, and Richard Wolf Medical Instruments Corp.