Power Morcellation and Recent Expert Concerns

“Power morcellation” is a common technique used by urogynecologic and other surgeons. Power morcellation involves breaking up tissue that is being pulled out of the abdominal cavity. Minimally invasive urogynecologic surgeries use very small incisions, which are often less than 1 inch long. It would be impossible to pull out surgically removed uteruses with large fibroids (leiomyomas) through these tiny incisions. Power morcellation allows surgeons to break up these large tissue masses so that we can pull them out of small incisions.

Without morcellation, many patients would not be able to have minimally invasive (laparascopic or robotic) hysterectomies. This is very important because minimally invasive hysterectomies have been proven to be safer and better for patients than open surgeries with large incisions.

Power morcellation in gynecologic surgery has recently received much attention. There is concern about the risk of spreading an undiagnosed uterine sarcoma (a type of cancer). Typically, power morcellators are tools with a sharp, rotating blade that break up tissue into small pieces. Morcellation has been used commonly in patients undergoing laparoscopy or robotic surgery for fibroids.  In the process of making the fibroids small enough to come out of the incisions used in minimally invasive surgeries, pieces of the tissue can be spread throughout the abdomen.  If these fibroids contain undiagnosed cancer, the cancer could theoretically spread. The risk of unknown uterine cancer in women undergoing hysterectomy for fibroids is approximately 2 in 1000.

Power morcellation is also sometimes performed when hysterectomy is done at the time of sacrocolpopexy. The concern about spreading cancer during power morcellation does not pertain to these hysterectomies as the uterus in patients undergoing sacrocolpopexy do not typically contain fibroids.

At Austin Urogynecology, we take this issue seriously. We are closely following FDA, AUGS (American Urogynecologic Society) and ACOG (American Congress of Obstetrics and Gynecology) guidelines. Our goal is to practice with the best information and the best technique to keep you as safe and healthy as possible.