STUDY OBJECTIVE:

To identify, collate and summarize the most common causes and pathologies of electric morcellation-related reoperations after laparoscopic myomectomy and non-myomectomy procedures.

DESIGN:

Systematic review of published medical literature from January 1990 to February 2014 reporting morcellation-related reoperations after laparoscopic myomectomy and non-myomectomy procedures involving the use of intracorporeal electric tissue morcellators. Publications were included in this review if patients underwent a second surgical procedure due to the onset of new clinical symptoms after a primary surgical procedure that involved intracorporeal morcellation, or if histopathology of the morcellated surgical specimen revealed malignancy.

DESIGN:

Classification: II-3 SETTING: All case reports and case series were reported from community and academic hospitals in the U.S.A. and the rest of the world.

PATIENTS:

We identified 66 patients from 32 publications.

INTERVENTIONS:

Reoperation after laparoscopic myomectomy and non-myomectomy procedures involving intracorporeal electric tissue morcellation.

MEASUREMENTS AND MAIN RESULTS:

For patients who presented with new clinical symptoms requiring reoperation, we recorded the follow-up period, nature and duration of the new symptoms, details of the second surgical procedure, intraoperative findings during the second surgical procedure, and the final histopathologic diagnosis. When histopathology of the morcellated specimen revealed malignancy, we recorded the specific type of malignancy, the corresponding surgical treatment that the patient underwent and the follow-up period. Percentages and 95% confidence intervals were calculated for all categorical variables. Twenty-four (36.4%) patients underwent laparoscopic myomectomies, of which, nineteen (79.2%) and 5 (20.8%) patients required a second surgical procedure due to new clinical symptoms and the diagnosis of malignancy in the morcellated surgical specimen, respectively. Forty-two (63.6%) patients underwent laparoscopic hysterectomies; of these, twenty-five (59.5%) patients required a second surgical procedure due to the onset of new clinical symptoms, while the remaining 17 (40.5%) patients underwent a second surgical procedure due to the diagnosis of malignancy in the morcellated surgical specimen. The most common benign pathology was parasitic leiomyomata (22 patients, 33.3%). The most common malignant pathology was leiomyosarcoma (16 patients, 24.2%).

CONCLUSION:

Dispersion of tissue fragments into the peritoneal cavity at the time of morcellation continues to be a concern. It was previously thought that morcellated tissue fragments are resorbed by the peritoneal cavity; however, there is some evidence highlighting the long-term sequelae related to growth and propagation of these dispersed tissue fragments in the form of parasitic leiomyomata, iatrogenic endometriosis and cancer progression. Yet, the majority of laparoscopic myomectomy and non-myomectomy procedures involving the use of intracorporeal electric tissue morcellators are uncomplicated, and institutions having no women with endometriosis or cancer are very unlikely to report surgical outcomes of uneventful electric morcellation. Thus, prospective studies are still required to validate the role of electric intracorporeal tissue morcellation in the pathogenesis of parasitic leiomyomata, iatrogenic endometriosis and cancer progression.

Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.