Power Morcellator – A Deadly Twist

The power morcellator, a surgical device used to mince large masses of tissue inside the body so the material can be extracted through small incisions, has been the center of a debate in the medical community since the Food and Drug Administration (“FDA”) discouraged its use in April, 2014. The FDA discouraged the use of these devices because morcellation, or the dividing of tissue into smaller pieces or fragments, can spread cancerous tissue.

In laparoscopic hysterectomies, a morcellator is used to mince the uterus into smaller pieces in order to extract it from the abdomen. At the 2015 Annual Meeting on Women’s Cancer, there was a presentation by J. A. Ducie, of Memorial Sloan Kettering Cancer Center, K. Fritton of Thomas Jefferson University, R. O’Cearbhaill of Memorial Sloan Kettering Cancer Center, M. L. Hensley, of Weill Cornell Medical College , R. A. Soslow of Memorial Sloan Kettering Cancer Center, N. R. Abu-Rustum of Memorial Sloan Kettering Cancer Center, M. M. Leitao and O. Zivanovic of Memorial Sloan Kettering Cancer Center, on the impact of intraoperative tumor fragmentation or morcellation with early-stage uterine leiomyosarcoma.

They presented a study concerning the impact of intraoperative tumor fragmentation or morcellation on the outcomes of patients with uterine leiomyosarcoma (a rare uterine malignancy that arises from the smooth muscle of the uterine wall). Compared with other types of uterine cancers, leiomyosarcoma is an aggressive tumor associated with a high risk of recurrence and death, regardless of stage at presentation. They identified all patients that were diagnosed with this form of cancer in their institution between 2000 – 2014. All operative notes were reviewed.

Intraoperative tumor fragmentation was noted in 32 (23.5%) cases; of these, 15 (46.9%) underwent morcellation. Median overall survival was 45.3 months in patients with intraoperative tumor fragmentation or morcellation compared with 105.2 months in the control group. They determined that tumor fragmentation or morcellation negatively impacts survival.