Today, we are going to talk about morcellation, which is a surgical technique that is used to break large tissues into smaller pieces so they can be removed through small incisions. This technique is often used during minimally invasive surgeries, such as laparoscopic hysterectomies and myomectomies, to avoid open surgery, large incisions, and lengthy recovery times.
Morcellation techniques have changed some over the years due to safety concerns. In this article, we will talk about power morcellation, the morcellation of fibroids, and the uterine morcellation controversy, as well as an alternate way to remove fibroids that does not use morcellation.
Surgery to Remove Large Fibroids
Uterine fibroids are growths that form in or on the uterus and can cause a host of painful and life-interrupting symptoms. Fibroids can be tiny, or they can grow very large, with the largest ever recorded fibroid weighing in at 140 pounds. Thankfully, most fibroids do not ever get this large, but many women experience fibroids that do grow quite large and begin to cause painful symptoms. One of the most common symptoms, caused by fibroids, is very heavy bleeding that lasts longer than normal, which can decrease your quality of life and cause serious medical conditions.
An OB/GYN often uses surgery to remove fibroids to help relieve their symptoms, such as a hysterectomy or a myomectomy. Historically, these surgeries were performed “openly,” meaning a long incision was used to allow the surgeon to gain access to the uterus to remove the fibroids. These days, most fibroid removal surgeries are performed laparoscopically using just a small number of small incisions that are created in the patient’s abdomen. A special medical device called a laparoscope, which has a camera attached, is used to help the surgeon navigate the procedure while watching their progress on a monitor located near them.
What Is the Morcellation of Fibroids?
The morcellation of fibroids is a procedure that cuts up a large fibroid into smaller pieces so it can be easily removed through little incisions that are created in their abdomen.
You may be familiar with the term “power morcellation”, which involves a device with rotating blades called a power morcellator that is used to quickly and easily cut tissue into small fragments. This allows surgeons to remove large uterine fibroids or even the entire uterus through small incisions, making the procedure less invasive. The first power morcellator for gynecologic use was approved by the FDA in 1995.
You may wonder, “Why would a surgeon need to use power morcellation to remove fibroids?” In the late 1990s and early 2000s, this technique became very popular because it helped surgeons remove large fibroids and even the entire uterus using only very small incisions made in the patient’s abdomen, vs. using open surgery. This meant shorter operating times and a shorter, less painful recovery for the patient.
What Is the Uterine Morcellation Controversy?
For years, power morcellation was seen as a smart way to remove large fibroids or even the whole uterus during a minimally invasive surgery and a good way to avoid open surgery.
But in 2014, the FDA issued a strong warning because they found that in about 1 in 350 women having surgery for what looked like harmless fibroids, the tissue actually contained an aggressive cancer called uterine sarcoma. When a power morcellator was used, it could chop up and scatter those cancer cells throughout the abdomen, which made the cancer harder to treat and actually gave it a chance to spread faster.
This caused a big stir in the medical world, which is often referred to as the “uterine morcellation controversy.” Many hospitals stopped using power morcellators, and some companies, like Johnson & Johnson, pulled their morcellation products from the market.
Is Morcellation Still Used?
Yes, but the guidelines for using morcellation have been updated, and the procedure now has significant restrictions. Today, if morcellation is used, surgeons must use containment systems, such as a surgical bag, to help contain any hidden cancer cells and lower the risk of spreading them. The use of power morcellation has significantly declined, but it is still used in certain cases when the benefits outweigh the potential risks.
The American College of Obstetricians and Gynecologists (ACOG) advises that morcellation should be avoided in women with known or suspected uterine cancer and recommends each woman receive a thorough preoperative evaluation to assess the risk of malignancy before proceeding with morcellation.
What Are the Risks of Morcellation?
The primary risk is the potential spread of undiagnosed cancerous cells, particularly uterine sarcomas, during the morcellation process. This can worsen the patient’s prognosis by spreading the cancer cells within the abdominal cavity. Other risks include injury to surrounding organs and the possibility of leaving behind tissue fragments that could lead to complications.
Can Laparoscopic Hysterectomy Be Done Without Morcellation?
Yes. Alternatives include removing the uterus through the vagina or making a slightly larger abdominal incision to extract the tissue as a whole. These methods avoid the need to cut the tissue into smaller pieces and reduce the risk of spreading undetected cancer.
The best option would be to avoid removing the uterus at all and only proceed if 100% medically necessary. Studies show that out of the 600,000 hysterectomies that are performed each year in the United States, only about 10% of them are medically necessary. Most hysterectomies are performed to remove uterine fibroids and alleviate their symptoms. There is a better, non-surgical treatment for uterine fibroids that leaves your uterus intact, but most women are not made aware of this option by their OB/GYN.
Besides the risks of the morcellation process itself, research has shown that women who lose their uterus, especially at a younger age, have an increased risk for heart disease, stroke, dementia, and other serious medical conditions.
What Is Better Than the Morcellation of Fibroids?
Morcellation was used to remove large uterine fibroids while using only minimally invasive surgery. Breaking the fibroids into smaller pieces made it easier for surgeons to remove them through small incisions, reducing recovery time and surgical risks. However, due to the associated cancer risks, its use has become more limited, and there is a much better way to eliminate fibroids without having to use surgery.
Uterine fibroid embolization (UFE) is a non-surgical procedure that is performed by an interventional radiologist and not an OB/GYN. Fibroids need a blood supply to stay alive and to grow, so they attach themselves to a blood vessel that is directly connected to the uterine artery and begin to siphon blood. During the UFE procedure, the interventional radiologist uses a special catheter to deliver tiny beads into each blood vessel that has been hijacked by a fibroid. The beads permanently block the flow of blood to the fibroids, and they shrink and die, which eliminates their symptoms and removes the need for further treatment or surgery.
Who Performs UFE?
The Atlanta Fibroid Center, founded by Dr. John Lipman, has been helping women for over 30 years to regain their quality of life after breaking free of fibroid symptoms. Many women have traveled great distances, from other states and countries, to take advantage of Dr. Lipman’s extensive experience and knowledge.
Many women who have undergone the UFE procedure were able to fulfill their dream of becoming a mother, and Dr. Lipman’s picture-covered office wall is a testament to all the babies who would never have been born if their moms had gone ahead with a hysterectomy. Dr. Lipman and Dr. Banerjee have now partnered to expand their services to women suffering from this condition. Set up your in-person or virtual consultation with us to learn more about how uterine fibroid embolization can help you take back your life without surgery or losing your uterus.
