Patients Should Know: Power Morcellation to Treat Uterine Fibroids May Spread Cancer

The surgical procedure called power morcellation has become a popular treatment for uterine fibroids.  Laparoscopic power morcellators are electric surgical devices.   Morcellation refers to the cutting up of tissue into smaller pieces or fragments.  The technique involves insertion of a tiny instrument with rapidly spinning blades, the morcellator, used to break up the fibroids so that they can be sucked out of the body through a small incision site.  The benefits of this technique include that it is minimally invasive and shortens recovery time.

The problem with the power morcellation technique is that the blades can spray uterine tissue or fibroids around the inside of the abdomen and pelvis.  Even benign tissue can take hold and grow on organs, causing pain, infection, or bowel obstruction.  In women with unsuspected uterine sarcomas, a type of cancer, the blades can spray cancer cells through the woman’s abdomen and pelvis, which may cause advanced cancer.

The CDC estimates that 600,000 hysterectomies (removal of the uterus) are performed annually in the United States to treat uterine fibroids.  In a news release posted by the FDA on April 4, 2014, the agency estimated that 1 in 350 women who undergo hysterectomy or myomectomy (removal of the uterine fibroids) is found to have unsuspected uterine sarcoma.  On March 5, 2014, an article entitled, “Evaluating the Risks of Electric Uterine Morcellation” was published in The Journal of the American Medical Association (JAMA).  Dr. Kimberly Kho, a co-author of the JAMA article, said that she and a colleague at the University of Texas Southwestern Medical Center observed several years ago that they began seeing patients with abdominal problems following morcellation of uterine fibroids or the uterus.  The patients needed additional surgery to remove lumps of uterine tissue or fibroids that were growing on the liver, appendix, or bladder.

A case in Boston reported by the Wall Street Journal in December 2013, has drawn nationwide attention to the cancer risk regarding uterine morcellation.  In the case, a 41 year old radiologist and mother of six had morcellation to remove fibroids, and was later found to have advanced cancer, probably from a hidden sarcoma that was cut up by the morcellator and sprayed throughout the abdomen.  The radiologist, Amy J. Reid, M.D., now has a Stage 4 leiomyosarcoma, which is an aggressive uterine cancer.  Dr. Reid and her physician husband, Hooman Noorchashm, M.D.,  have campaigned to persuade surgeons to stop using morcellation.  Dr. Noorchashm’s petition to stop morcellation is posted at change. org.

Because of the many benefits of minimally invasive surgery, Dr. Kho does not believe that uterine morcellation should be banned.  However, she does advocate more prudent and conservative screening of patients to detect sarcomas and prevent morcellating cancers.  She also favors the intra-operative use of a bag to enclose the tissue that is to be morcellated.  Morcellating the tissue inside the bag reduces the risk of spreading the chopped up tissue inside the abdomen.  The technique is called closed morcellation, and is now in use at Brigham and Women’s Hospital in Boston.  Few gynecologists know how to perform this technique, and it reportedly takes months to learn.  Doctors at Brigham and Women’s discuss with their patients the risks of power morcellation.  Robert Barbieri, M.D. of Brigham and Women’s estimates that the risk of hidden sarcoma in women with fibroids could be as high as 1 in 400.