Hysterectomy and Power Morcellation
A hysterectomy is not always just one type of medical procedure. There are complete hysterectomies and partial ones, and the reasons for a hysterectomy vary widely from patient to patient. While some people will have them because of diseased tissue putting their health at risk or because of chronic pain caused by certain conditions, some people have them because of malformations or chronic bleeding.
Clearly, there are many reasons for a hysterectomy, and there are many ways they can be done. Surgeons will have to discuss their patient’s needs to determine the right options. For instance, the patient needs to be honest about the amount of time needed for recovery, if they are worried about scars, and so on.
There are really only two approaches that modern physicians choose – open surgery and MIP or minimally invasive surgery. Around 65% of hysterectomies are of the open kind, meaning that the abdominal area is opened with an incision up to seven inches in length and then the tissue is surgically removed. Obviously, this requires a lot more time to heal than a surgery that is done in a minimally invasive manner.
Minimally invasive procedures include a vaginal hysterectomy in which the uterus is removed via an incision inside of the vagina, or laparoscopic methods that rely on specialized tools (and even robot assisted systems) and tiny cameras to allow surgery to be done without opening the patient’s abdomen. One of the specialized tools used laparoscopically is the morcellator, and while it was once a preferred choice it has recently become a topic of heated debate.
The Morcellator
A power morcellator is a device that does just what it sounds like – it turns large amounts of tissue into morsels or tiny pieces. It does this to allow entire organs to be removed via the tubes of the laparoscopic tools. This, initially, sounds like a superior solution. The specialized devices are inserted into the abdomen through tiny incisions, and the tools then go to work making very precise cuts and removing the unwanted or unhealthy tissue or organ.
Unfortunately, the process is not as “clean” as it sounds and the FDA recently ruled that laparoscopic procedures with morcellator devices are contraindicated for uterine removal, including during hysterectomy.
Why? If you keep in mind that a morcellator breaks tissue into small pieces, it begins to make it easier to understand why there are risks. When tissue contains undiagnosed cancer cells, and this is then segmented by the morcellator, it allows many cells and bits of tissue to spread into the body. While the power morcellator is currently being identified as risky simply for allowing “parasitic” tissue to adhere to organs, it is the diseased tissue that is the worst.
LMS – A Hidden Threat
There is a form of cancer known as Leiomyosarcoma, or LMS, and it is often undiagnosed in women during the preoperative period. Rather, it is mistaken for fibroid tumors. These usually benign growths are a major reason for a woman to elect to have a hysterectomy, and yet when the LMS tissue is broken down by the morcellator it allows the cancer cells to disperse widely.
Because LMS is such an aggressive type of cancer, the use of the morcellator has suddenly become a very questionable one. It turns what was initially a treatable form of localized uterine LMS into a systemic disease that has a very poor prognosis.
If you are being told that hysterectomy is a good medical option and that a morcellator is going to be used to do the work, you will want to discuss it a length with your physician. The FDA recently stated that morcellators are contraindicated for hysterectomy and myomectomy. Instead, it is safest for patients to rely on an open or vaginal procedure rather than the laparoscopic one that can allow cells to spread and disseminate disease.
Source
WebMD. Hysterectomy. 2015. http://www.webmd.com/women/guide/hysterectomy?page=2