Posted by Bill Sandweg on 10 April 2019.
Here is a link to a story in today’s Wall Street Journal about the continued use of power morcellators. I have been writing in this blog about power morcellators for 4 years now. I have links here, here and here to some of my posts. The problem is that the power morcellator has the potential to spread aggressive cancers, if they are present, and make a bad situation worse.
Power morcellators are used by surgeons during laparoscopic procedures in the uterus to break up masses, such as uterine fibroids, so they can be removed easily through the small incisions that have been made for the surgical instruments. The morcellators act much as a blender does with rapidly rotating blades chewing up tissue into small bits. The small bits can then be washed out with saline solution and a vacuum. This all works very well unless the patient has an unknown cancer.
When power morcellators came on the market, they were embraced by the community of surgeons doing laparoscopic surgery. They provided a quick and easy solution to the problem of removing masses that would not fit through the small incisions created for the laparoscopic procedure. It took a number of years for the risks of their use to become clear.
It is estimated by the Food and Drug Administration (“FDA”) that one in 225 to one in 580 women who undergo laparoscopic uterine procedures have an aggressive cancer that has not detected by the time of the surgery. Most often, when this is the case, the cancer is masquerading as benign tissue. When the surgeon uses the power morcellator, the cancer is chopped up into thousands of small pieces. When the surgeon washes out the uterus with normal saline, some of the cancer cells are certain to be left behind and are now spread throughout the uterus.
When the dangers associated with power morcellators became known, the FDA faced a choice. It could ban them or it could restrict their use or it could choose a middle path and just issue a warning. The FDA chose to issue a warning that surgeons should not use power morcellators but did not limit their use. In response to the FDA’s warning, some hospitals prohibit surgeons practicing there from using power morcellators.
In spite of the FDA warning, some surgeons believe the threat is overblown and continue to use morcellators. Most surgeons, however, have found other means of removing the uterine masses they have cut out of the patient’s body. One of the alternatives for those who continue to use morcellators is to use a small bag into which the surgeon can place the mass or masses. The surgeon can then insert the power morcellator into the bag and break up the masses. The bag can then be removed through the incision. It is not clear whether this alternative fully protects women with unrecognized cancers. Other surgeons also use a bag but cut up the masses manually rather than using the power morcellator. Manually cutting up the mass avoids the creation of thousands of microscopic particles which may contain hidden cancer.
If you are going to have a laparoscopic procedure to remove uterine masses, you need to discuss with your surgeon how he or she intends to remove the masses. A one in 225 chance of spreading an aggressive cancer is not one I would recommend to my wife or daughters.