On women: Why should I care what a Power Morcellator is?

‘Power Morcellator’ until very recently was not a phrase I had ever uttered, but it seems women should be talking about this very thing.

In brief, a power morcellator is used in key-hole surgery to break fibroids into tiny pieces in gynaecological operations, making it easier to remove them and avoiding open surgery with its attendant risks such as infection and long recovery times.

However, there has been some worrying evidence emerging from the US that in women where the uterine fibroid turns out to be cancerous (about 1 in 350), their long term prognosis is severely reduced.

“Earlier this year, the United States Federal Drug Agency (FDA) expressed concern about women undergoing laparoscopic power morcellation for the treatment of uterine fibroids and the risk of inadvertent spread of unsuspected cancer (sarcoma) to the abdominal and pelvic cavities, and issued guidance on its use.” BRIEFING September 2014 – Sarcoma UK

ARC_MorcellationDiagram

The current explanation to account for this is tiny pieces of fibroid tissue are inevitably left behind in the pelvic cavity, which in the case of a malignancy aids the cancer in spreading throughout the abdomen. A way to reduce this risk (from my reading) is to use a bag to collect the tissue (so all the morcellated tissue is contained and removed), but this is not happening routinely at the moment, although the reason for this is unclear – may relate to cost as it makes procedure longer, or the fact that surgeons are not aware of this safety modification.

Clearly there are benefits to this method and I have not looked at data on mortality rates for alternative and possibly more invasive or complex surgical methods. This article from the Wall Street Journal gives the background to the campaign (started by a doctor whose wife developed stage 4 cancer after morcellation) and presents a relatively balanced view on this technique.

“Hooman Noorchashm isn’t a gynecologist, but his battle against a common—and potentially dangerous—hysterectomy procedure has triggered a heated debate and yielded changes in how it is done.”

Although there doesn’t seem to be any current cases in the UK, Sarcoma UK has published some guidelines to women about what to ask your surgeon and what to do if this method was used on you and you are now worried. NICE is apparently publishing guidelines on the use of power morcellators in fibroid surgery in October 2014. But until they do, I think it is important that women are made aware of this issue so they can make informed choices and be able to ask for an alternative surgical method if they are concerned.

If you want to know more about this issue click here for the American Recall Centre, but bear in mind the website is sponsored by WEITZ & LUXENBERG P.C., a law firm focusing on providing legal services to clients injured by negligent corporations and/or entities.

Are you about to have surgery for fibroids? Do you know what method is being used? Have the risks been fully explained to you?