The key factor for women considering surgical options to remove uterine fibroids is to be a well-informed patient and have a well-informed physician, according to a decision-tree analysis constructed by medical researchers investigating morcellation surgery.

The use of a power morcellator in hysterectomies or to remove uterine fibroids involves a medical device – the power morcellator – shredding the tumor into tiny pieces inside of the abdomen, enabling the surgeon to remove them laparoscopically. But gynecological morcellation has come under fire for the potential of spreading cancer throughout the abdomen, resulting in a more advanced stage of the disease.

Morcellation and Informed Consent

In constructing the decision tree, researchers relied on morbidity and mortality data from 26 earlier morcellation studies conducted over several decades. They found that women who underwent laparoscopic hysterectomy with morcellation experienced fewer surgical complications as well as an increased quality of life, compared with women who underwent abdominal hysterectomy for presumed uterine fibroids.

On the flip side, there were more deaths from leiomyosarcoma – a smooth muscle connective tissue tumor – following laparoscopic hysterectomy.

“Obstetrician-gynecologists understand that total abdominal hysterectomy has higher rates of morbidity and mortality than less-invasive alternatives, including those conducted with morcellation,” according to Georgetown University Hospital’s Dr. Hal Lawrence, who is also the executive vice president and CEO of the American College of Obstetricians and Gynecologists.

“Based on previous data, we continue to assert that vaginal hysterectomy offers patients fewer complications and better outcomes for patients, so is the preferred route of hysterectomy when possible. Of course, there is no one-size-fits-all solution for the treatment of fibroids. Not all women are indicated for vaginal hysterectomy, so it is essential that laparoscopic hysterectomy with morcellation and total abdominal hysterectomy continue to be available as treatment options.”

The ideal is “true informed consent,” Obstetrician/Gynecologist Dr. Diana Bitner told MedPage Today.

“I agree with the findings and think women deserve informed consent that, while cancer being spread is a risk of morcellation, most women do not have cancer to be spread and … so many other risks [are reduced] with laparoscopic surgery,” according to Dr. Bitner, who is director of Women’s Health Network at Spectrum Health in Grand Rapids, Mich.

“As a pelvic surgeon, it will kill me to go backwards and go back to open surgery when minimally invasive could be so much safer, reduce hospital time, time off work, pain, and need for narcotics, etc.”

Morcellation Safety Concerns

In 21014, the FDA issued a safety advisory after analyzing data that showed morcellation surgery might cause the spread of unsuspected cancerous tissue outside the uterus.  The FDA ultimately decided not to ban morcellators but contraindicated the device for removal of uterine tissue in menopausal and post-menopausal women, and in women who are eligible for surgeries that remove uterine tissue intact i.e. through the vagina or mini-laparotor.

Morcellation cancer lawyers are looking for women diagnosed with leiomyosarcoma (LMS), uterine sarcoma or other cancer within two years after their initial morcellation surgery to remove fibroids, the uterus, ovaries or fallopian tubes.