Complications of Laparoscopic Morcellation: Two Cases and a Review of the Literature

Abstract

Abstract

Background:

Laparoscopic power morcellation has revolutionized laparoscopic surgery by facilitating removal of large uterine masses through small incisions. Recently, there has been a debate on the use of this technique in view of iatrogenic dissemination of myoma tissue necessitating further medical or surgical interventions. Despite meticulous retrieval of all pieces and thorough irrigation, some fragments can elude detection, giving rise to disseminated peritoneal leiomyomatosis or disseminated sarcoma in an undetected malignancy. These complications could require reintervention and may upstage the disease in sarcoma, which worsens patient prognosis.

Cases:

This article reports on 2 cases with complications after laparoscopic morcellation. The first patient had port-site recurrence of a leiomyoma, 3 years after laparoscopic hysterectomy for multiple uterine fibroids, when specimen was removed by power morcellation. The second patient underwent laparoscopic myomectomy for fibroid uterus and the specimen was removed by morcellation. She presented 5 years later with port-site and multiple intraperitoneal leiomyomas.

Results:

After thorough investigation, the first patient was operated on laparoscopically but histopathologic examination revealed leiomyosarcoma; however, on follow-up no recurrence was reported. The second patient underwent radical surgery with removal of all leiomyomata, the uterus, and the omentum. There was no recurrence reported in the second patient on follow-up.

Conclusions:

Reducing accidental spread of uterine malignancy and, at the same time, preserving the benefits of a minimally invasive approach requires careful patient selection, counseling of patients, informed consent, and alternative methods of tissue extraction. These methods include contained morcellation. (J GYNECOL SURG 34:31)