Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology

Taşkın, Salih; Varli, Bulut; Taskiran, Cagatay; Yalcin, Ibrahim; GUNGOR, Mete; ortaç, fırat

doi:10.4274/jtgga.galenos.2020.2020.0107

Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology

Salih TAŞKIN, (Ankara Üniversitesi Tıp Fakültesi Jinekolojik Onkoloji Anabilim Dalı, Türkiye)

Bulut VARLI, (Ankara Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Ankara, Türkiye)

İbrahim YALÇIN, (Ondokuz Mayıs Üniversitesi Tıp Fakültesi Jinekolojik Onkoloji Anabilim Dalı, Türkiye)

Çağatay TAŞKIRAN, (Koç Üniversitesi Tıp Fakültesi Jinekolojik Onkoloji Anabilim Dalı, Türkiye)

Fırat ORTAÇ, (Ankara Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı, Türkiye)

Mete GÜNGÖR (Acıbadem Üniversitesi Tıp Fakültesi Jinekolojik Onkoloji Anabilim Dalı, Türkiye)

Journal of the Turkish-German Gynecological Association

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Yıl: 2021 Cilt: 22 Sayı: 1 Sayfa Aralığı: 53 - 57 Metin Dili: İngilizce DOI: 10.4274/jtgga.galenos.2020.2020.0107 İndeks Tarihi: 06-05-2021

Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology

Öz:

Morcellation allows the removal of a large uterus and fibroids through small incisions with minimally invasive surgery. It helps to prevent the complications associated with large incisions in both hysterectomy and myomectomy operations. Currently, there is much debate regarding the use of power morcellation in laparoscopic hysterectomy and myomectomy, mainly due to the risk of peritoneal dissemination of undiagnosed uterine sarcomas. Unfortunately, there is no valid pre-operative diagnostic method that can differentiate sarcomas from myomas, and the currently available scientific literature regarding morcellation is insufficient. As the Turkish Society of Minimally Invasive Gynecological Oncology, we present our consensus opinion and suggestions for the preoperative evaluation and morcellation of fibroids, in line with the recent literature. (J Turk Ger Gynecol Assoc 2021; 22: 53-7)

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Langenbeck CJM. Nosology and Therapy of Surgical Illnesses. Gottingen, Germany: 1845.
2. Semm K. Pelviscopy and Hysteroscopy: Color Atlas and Textbook. New York: Schattauer; 1976.
3. Mettler L, Semm K, Lehmann-Willenbrock L, Shah A, Shah P, Sharma R. Comparative evaluation of classical intrafascialsupracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy-our first 200 cases. Surg Endosc 1995; 9: 418-23.
4. Perri T, Korach J, Sadetzki S, Oberman B, Fridman E, Ben-Baruch G. Uterine leiomyosarcoma: does the primary surgical procedure matter? Int J Gynecol Cancer 2009; 19: 257-60.
5. Park JY, Park SK, Kim DY, Kim JH, Kim YM, Kim YT, et al. The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 2011; 122: 255-9.
6. US Food and Drug Administration. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication, c.2104 Apr 17 (cited 2017 July 6) Available from: https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices
7. FDA UPDATED laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication FDA, 24 (2014, November) Retrieved from: http://www.fda. gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm [13.09.15]
8. Halaska MJ, Haidopoulos D, Guyon F, Morice P, Zapardiel I, Kesic V, et al. European society of gynecological oncology statement on fibroid and uterine morcellation. Int J Gynecol Cancer 2017; 27: 189-92.
9. Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, et al. Options on fibroid morcellation: a literature review. Gynecol Surg 2015; 12: 3-15.
10. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol 2014; 21: 517-30.
11. Beckmann MW, Juhasz-Böss I, Denschlag D, Gaß P, Dimpfl T, Harter P, et al. Surgical methods for the treatment of uterine fibroids - risk of uterine sarcoma and problems of morcellation: position paper of the DGGG. Geburtshilfe Frauenheilkd 2015; 75: 148-64.
12. Statement of the Society of Gynecologic Oncology to the Food and Drug Administration's Obstetrics and Gynecology Medical Devices Advisory Committee Concerning Safety of Laparoscopic Power Morcellation. SGO,2014, July. [13.09.15] Available from: https:// www.sgo.org/wp-content/uploads/2014/04/SGO-Testimony-toFDA-on-Power-Morcellation-FINAL.pdf
13. Rousseau M, Morel A, Dechoux S, Bouet PE, Catala L, Lefebvre Lacoeuille C, et al. Can the risks associated with uterine sarcoma morcellation really be prevented? Overview of the role of uterine morcellation in 2018. J Gynecol Obstet Hum Reprod 2018; 47: 341-9.
14. Pritts EA, Vanness DJ, Berek JS, Parker W, Feinberg R, Feinberg J, et al. The prevalence of occult leiomyosarcoma at surgery for presumed uterine fibroids: a meta-analysis. Gynecol Surg 2015; 12: 165-77.
15. Tan-Kim J, Hartzell KA, Reinsch CS, O'Day CH, Kennedy JS, Menefee SA, et al. Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol 2015; 212: 594.e1-594.e10.
16. Topdagi Yilmaz EP, Cimilli Senocak GN, Topdagi YE, Aynaoglu Yildiz G, Kumtepe Y. Incidence of occult malignancies identified during hysterectomies performed for benign indications. J Gynecol Obstet Hum Reprod 2020; 49: 101620.
17. Yorgancı A, Meydanlı MM, Kadıoğlu N, Taşkın S, Kayıkçıoğlu F, Altın D, et al. Incidence and outcome of occult uterine sarcoma: a multicentre study of 18604 operations performed for presumed uterine leiomyoma. J Gynecol Obstet Hum Reprod 2020; 49: 101631.
18. Cohen A, Tulandi T. Long-term sequelae of unconfined morcellation during laparoscopic gynecological surgery. Maturitas 2017; 97: 1-5.
19. Tasci T, Karalok A, Taskin S, Ureyen I, Kimyon G, Tulek F, et al. Does lymphadenectomy improve survival in uterine leiomyosarcoma? Int J Gynecol Cancer 2015; 25: 1031-6.
20. Raine-Bennett T, Tucker LY, Zaritsky E, Littell RD, Palen T, Neugebauer R, et al. Occult uterine sarcoma and leiomyosarcoma: incidence of and survival associated with morcellation. Obstet Gynecol 2016; 127: 29-39.
21. Bogani G, Cliby WA, Aletti GD. Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis. Gynecol Oncol 2015; 137: 167-72.
22. Oduyebo T, Rauh-Hain AJ, Meserve EE, Seidman MA, Hinchcliff E, George S, et al. The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol 2014; 132: 360-5.
23. Rivard C, Salhadar A, Kenton K. New challenges in detecting, grading, and staging endometrial cancer after uterine morcellation. J Minim Invasive Gynecol 2012; 19: 313-6.
24. Cohen SL, Morris SN, Brown DN, Greenberg JA, Walsh BW, Gargiulo AR, et al. Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016; 214: 257.e1-257.e6.
25. Solima E, Scagnelli G, Austoni V, Natale A, Bertulessi C, Busacca M, et al. Vaginal uterine morcellation within a specimen containment system: a study of bag integrity. J Minim Invasive Gynecol 2015; 22: 1244-6.
26. Parker WH, Fu YS, Berek JS. Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet Gynecol 1994; 83: 414-8.
27. Schwartz LB, Diamond MP, Schwartz PE. Leiomyosarcomas: clinical presentation. Am J Obstet Gynecol 1993; 168 (1 Pt 1): 180-3.
28. Bansal N, Herzog TJ, Burke W, Cohen CJ, Wright JD. The utility of preoperative endometrial sampling for the detection of uterine sarcomas. Gynecol Oncol 2008; 110: 43-8.
29. Aviram R, Ochshorn Y, Markovitch O, Fishman A, Cohen I, Altaras MM, et al. Uterine sarcomas versus leiomyomas: gray-scale and Doppler sonographic findings. J Clin Ultrasound 2005; 33: 10-3.
30. Kurjak A, Kupesic S, Shalan H, Jukic S, Kosuta D, Ilijas M. Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography. Gynecol Oncol 1995; 59: 342-6.
31. Bonneau C, Thomassin-Naggara I, Dechoux S, Cortez A, Darai É, Rouzier R. Value of ultrasonography and magnetic resonance imaging for the characterization of uterine mesenchymal tumors. Acta Obstet Gynecol Scand 2014; 93: 261-8.
32. Goto A, Takeuchi S, Sugimura K, Maruo T. Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer 2002; 12: 354-61.
33. Thomassin-Naggara I, Dechoux S, Bonneau C, Morel A, Rouzier R, Carette MF, et al. How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 2013; 23: 2306- 14.
34. Lin G, Yang LY, Huang YT, Ng KK, Ng SH, Ueng SH, et al. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging 2016; 43: 333-42.
35. Di Cello A, Borelli M, Marra ML, Franzon M, D'Alessandro P, Di Carlo C, et al. A more accurate method to interpret lactate dehydrogenase (LDH) isoenzymes' results in patients with uterine masses. Eur J Obstet Gynecol Reprod Biol 2019; 236: 143-7.
36. Nagai T, Takai Y, Akahori T, Ishida H, Hanaoka T, Uotani T, et al. Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass. Springerplus 2014; 3: 678.
37. Lynam S, Young L, Morozov V, Rao G, Roque DM. Risk, risk reduction and management of occult malignancy diagnosed after uterine morcellation: a commentary. Womens Health (Lond) 2015; 11: 929-44.
38. Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol 2017; 145: 208-16.
39. Graebe K, Garcia-Soto A, Aziz M, Valarezo V, Heller PB, Tchabo N, et al. Incidental power morcellation of malignancy: a retrospective cohort study. Gynecol Oncol 2015; 136: 274-7

APA	Taşkın S, Varli B, Yalcin I, Taskiran C, ortaç f, GUNGOR M (2021). Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. , 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
Chicago	Taşkın Salih,Varli Bulut,Yalcin Ibrahim,Taskiran Cagatay,ortaç fırat,GUNGOR Mete Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. (2021): 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
MLA	Taşkın Salih,Varli Bulut,Yalcin Ibrahim,Taskiran Cagatay,ortaç fırat,GUNGOR Mete Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. , 2021, ss.53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
AMA	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. . 2021; 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
Vancouver	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. . 2021; 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
IEEE	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M "Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology." , ss.53 - 57, 2021. 10.4274/jtgga.galenos.2020.2020.0107
ISNAD	Taşkın, Salih vd. "Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology". (2021), 53-57. https://doi.org/10.4274/jtgga.galenos.2020.2020.0107

APA	Taşkın S, Varli B, Yalcin I, Taskiran C, ortaç f, GUNGOR M (2021). Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. Journal of the Turkish-German Gynecological Association, 22(1), 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
Chicago	Taşkın Salih,Varli Bulut,Yalcin Ibrahim,Taskiran Cagatay,ortaç fırat,GUNGOR Mete Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. Journal of the Turkish-German Gynecological Association 22, no.1 (2021): 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
MLA	Taşkın Salih,Varli Bulut,Yalcin Ibrahim,Taskiran Cagatay,ortaç fırat,GUNGOR Mete Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. Journal of the Turkish-German Gynecological Association, vol.22, no.1, 2021, ss.53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
AMA	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. Journal of the Turkish-German Gynecological Association. 2021; 22(1): 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
Vancouver	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology. Journal of the Turkish-German Gynecological Association. 2021; 22(1): 53 - 57. 10.4274/jtgga.galenos.2020.2020.0107
IEEE	Taşkın S,Varli B,Yalcin I,Taskiran C,ortaç f,GUNGOR M "Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology." Journal of the Turkish-German Gynecological Association, 22, ss.53 - 57, 2021. 10.4274/jtgga.galenos.2020.2020.0107
ISNAD	Taşkın, Salih vd. "Morcellation in gynecology: short review andsuggestions from Turkish Society of Minimally InvasiveGynecologic Oncology". Journal of the Turkish-German Gynecological Association 22/1 (2021), 53-57. https://doi.org/10.4274/jtgga.galenos.2020.2020.0107