Laparoscopic myomectomy and morcellation: A review of techniques, outcomes, and practice guidelines

Laura M. Glaser*, Jaclyn Friedman, Susan Tsai, Angela Chaudhari, Magdy Milad

*Corresponding author for this work

Research output: Contribution to journalReview article

10 Scopus citations

Abstract

Laparoscopic myomectomy is a minimally invasive surgical approach to treat symptomatic uterine fibroids in women wishing for a uterine-sparing procedure. With careful patient selection, these procedures are associated with favorable reproductive outcomes and low perioperative morbidity. Current available methods for specimen retrieval include power and hand morcellation. The 2014 FDA safety warnings regarding power morcellation arose from concerns about the spread of occult malignancy and prompted widespread use of containment systems that may limit spread of myometrial cells. Investigation into the clinical effects of laparoscopic myomectomy and uncontained morcellation on the prognosis and spread of occult leiomyosarcoma has yielded mixed results. Other complications of uncontained power morcellation exist, including the development of parasitic leiomyomas. The FDA safety warnings have greatly influenced trends in benign gynecologic surgery, and survey data reflect trends in providers' opinions of these trends. In conclusion, recommendations for the current practice of laparoscopic myomectomy and morcellation are reviewed.

Original languageEnglish (US)
Pages (from-to)99-112
Number of pages14
JournalBest Practice and Research: Clinical Obstetrics and Gynaecology
Volume46
DOIs
StatePublished - Jan 2018

Keywords

  • Laparoscopic myomectomy
  • Leiomyosarcoma
  • Power morcellation

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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