Laparoscopic Hysterctomy Morcellation May Spread Diseases Other Than Cancer

In a finding that could dramatically increase the number of women at risk of complications from uterine fibroid morcellation, researchers from Johns Hopkins indicate that the controversial medical devices used during laparoscopic hysterectomy and myomectomy procedures may inadvertently spread more than just cancer cells. 

In the January issue of the medical journal Obstetrics & Gynecology, researchers outline reports of problems experienced by three women who underwent laparoscopic hysterectomy morcellation, with all three cases resulting in benign uterine diseases other than cancer being spread throughout their body.

Power morcellators are medical devices introduced in recent years for use during laparoscopic hysterectomy and myomectomy procedures for uterine fibroid removal, allowing doctors to cut up the uterus or fibroids through a small incision in the abdomen. The tissue is then removed through the incision, resulting in smaller scars, shorter recovery times and reduced risk of infection or other complications.

In recent months, concerns have emerged about the risk of morcellation spreading leiomyosarcoma, endometrial stromal sarcoma or other uterine cancers that may be contained within the uterus before the procedure.

Since about one in 350 women undergoing laparoscopic hysterectomy morcellation for uterine fibroids may have unsuspected sarcoma, which doctors are unable to detect or diagnose before surgery, many have called for the devices to no longer be used due to the high risk of disseminating uterine cancer.

These new reports suggest that the risks associated with power morcellators may extend beyond cancer, potentially resulting in the spread of benign diseases as well, which may lead to tumor growths and other complications.

In one case outlined by researchers, a 36-year-old woman with four children was found to have numerous soft tissue tumors that developed after a laparoscopic hysterectomy. The tumors were so extensive that doctors had to remove parts of her ovaries, colon, spleen, diaphragm, and other organs.

Another case involved a 51-year-old mother of two who reported suffering abdominal pain, nausea, and vomiting after her power morcellation hysterectomy. She was found to have developed a bowel obstruction and a mass in her pelvis that required removal of her right ovaries and fallopian tubes.

The third woman was another 51-year-old mother of two who developed a 15 centimeter abdominal mass that adhered to parts of her ureters, bladder, colon, omentum, left ovary and fallopian tube, all of which had to be resectioned to remove the mass. The growth caused her to suffer abdominal pain, painful urination and pressure on her pelvis.

“Each woman required a laparotomy and extensive, multiorgan resection to clear the disease,” the researchers noted. “Even in the setting of benign conditions, open power morcellation of the uterus may be associated with clinically significant dissemination of uterine disease.”

Power Morcellator Risks

Power morcellators have been used in an estimated 50,000 hysterectomy and myomectomy procedures each year, and many women subsequently diagnosed with uterine cancer dissemination are just now learning that their problems may have been caused by a power morcellator. However, the findings of this new research suggest that many more women may be experiencing complications as a result of these dangerous devices.

This summer, an FDA advisor panel determined there was no safe way to use power morcellators. However, the panel of outside experts could not decide on whether to recommend the devices be recalled or whether a black box warning should be added.

Although many have called for a power morcellator recall to be issued, the FDA announced last month that the devices will remain available with a stronger “black box” warnings about the risk of cancer being spread. The agency also contraindicated the devices for most women who would have qualified for the procedures

A number of hysterectomy morcellation cancer lawsuits are now being pursued on behalf of individuals diagnosed with leiomyosarcoma or endometrial stromal sarcoma. The findings may also result in additional product liability lawsuits against the manufacturers on behalf of women who experienced morcellator complications other than cancer.