Pathology of Power Morcellation: A 12-Year Retrospective Analysis

Objective: The goal of this research was to evaluate the risk associated with dissemination in laparoscopic procedures with power morcellation for benign gynecologic indications. Materials and Methods: This was a retrospective cohort study. A retrospective analysis was completed for cases of consecutive women who underwent laparoscopic myomectomy or supracervical hysterectomy with morcellation at a single academic institution between 2002 and 2014. The demographics and clinical characteristics of the patients were abstracted from the electronic medical records. Results: There were 456 women who underwent power morcellation during the study period. The majority (78%) was premenopausal with a median body mass index of 26 (range: 19-50). The most common preoperative diagnoses were fibroids, abnormal uterine bleeding, and pelvic organ prolapse. Eighteen percent of patients underwent myomectomy and 82% underwent supracervical hysterectomy. General gynecologists performed 58% of the surgeries, followed by urogynecologists (22%). Sixty-six percent of patients underwent preoperative uterine evaluation with at least an ultrasound or endometrial sampling, with 21% having undergone more than one modality. Patients with a diagnosis of fibroids were more likely to undergo preoperative endometrial sampling than patients with other diagnoses (32% versus 16%; p < 0.05). One uterine specimen (0.2%) had an undiagnosed atypical leiomyoma with moderate-to-severe cytologic atypia. Conclusions: The incidence of occult malignancy discovered on pathology following power morcellation of the uterus and/or fibroids is low in women. These data can be used to counsel patients prior to consideration of power morcellation. Given the limitations in preoperative diagnosis of sarcoma and potential complications of morcellation even of benign pathology, controlled morcellation should be a goal with established guidelines.