To Assess the Safety of Morcellation for Removing Uterine Specimen During Laparoscopic and Vaginal Hysterectomies for Leiomyomas

Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review

OBJECTIVE

This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas.

DATA SOURCES

Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020.

METHODS OF STUDY SELECTION

Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis.

TABULATION, INTEGRATION, AND RESULTS

The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen.

CONCLUSION

Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.

Occult Uterine Malignancy at the Time of Surgery for Pelvic Organ Prolapse: A Systematic Review and Meta-analysis

OBJECTIVE

To conduct a systematic review and meta-analysis to estimate the prevalence of occult uterine malignancy of any subtype specifically at the time of hysterectomy for pelvic organ prolapse (POP).

METHODS

We primarily used MEDLINE to access existing literature. The search terms used were "occult malignancy" or "occult uterine pathology" paired with "morcellation" or "hysterectomy." Our cutoff date for articles was March 25, 2019. We further narrowed articles down based on whether they included data on occult malignancy at time of hysterectomy specifically for POP.

RESULTS

Our search yielded a total of 233 journal articles, of which 53 met the criteria for a full-text review. Eight studies provided specific data on occult uterine malignancy among women undergoing surgery for POP and formed the basis for this meta-analysis. Among the 8 studies examined, the total number of patients combined was 35,880, and there were 144 total occult uterine malignancies. There were 7 case series and 1 population-based study included. The pooled prevalence of occult uterine malignancy at the time of hysterectomy for POP was 0.22% (95% confidence interval, 0.11%-0.35%]. There was very little heterogeneity observed across the 8 studies (I2 = 12.06%, Q χ2[7] = 7.96, P = 0.336).

CONCLUSIONS

The pooled prevalence of occult uterine malignancy, of any subtype, at the time of surgery for POP specifically is 0.22% based on meta-analysis of existing studies. Surgeons can use this statistic as part of the preoperative counseling of patients with POP before hysterectomy.