Purpose of Technology: Uterine fibroids, also known as myomas or leiomyomas, are benign tumors originating in the myometrium. Laparoscopic electromechanical morcellation of uterine fibroids involves the use of mechanically powered cutting devices to break up fibroid tissue for removal during minimally invasive myomectomy or hysterectomy. For standard laparoscopic myomectomy, morcellation is performed after complete enucleation of the myoma (removal of the myoma from the uterine wall). Alternative morcellation procedures include in situ morcellation, which is performed while the myoma is still attached to the uterus, and bagged morcellation, which is achieved within an enclosed flexible container to prevent tissue dissemination.
Rationale: Electromechanical morcellation (EMM) is 1 option for fibroid extraction through a small opening and the procedure is claimed to be relatively safe compared with open abdominal hysterectomy or myomectomy.
Controversy: There is substantial ongoing debate about the safety of laparoscopic EMM for removal of uterine fibroids during myomectomy or hysterectomy. EMM can disseminate fragmented tissues within the peritoneal cavity, which, in patients with previously undetected malignancy, can lead to cancer upstaging and reduced life expectancy. In 2014, the Food and Drug Administration (FDA) released a safety communication recommending against the use of laparoscopic EMM during hysterectomy or myomectomy for most women due to the risk of undiagnosed uterine sarcoma.
- How does laparoscopic EMM compare with alternative methods for removal of uterine fibroids during myomectomy or hysterectomy in terms of efficacy?
- How does laparoscopic EMM compare with alternative methods in terms of safety?
- How do procedural variations of EMM compare with each another in terms of efficacy and safety?
- Have definitive patient selection criteria been established for laparoscopic EMM of uterine fibroids?
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