More than 20 years ago, gynecologists had a problem. Doctors in other fields were quickly introducing minimally invasive surgery-"laparoscopic" procedures done through tiny incisions—to remove organs like gallbladders and kidneys. But a uterus filled with fibroids, common benign growths that affect a high percentage of women, can be far too cumbersome for this method. While there have long been ways to do laparoscopic hysterectomies, gynecologists say difficulty combined with lack of training slowed them down.
That's where power morcellators came in. Here are five things to know:
By Jennifer Levitz and Jon Kamp
Doctors don't need powered morcellators, but they sure help. Medical articles occasionally described tennis-elbow-like injuries for doctors wielding older, manual morcellators. In contrast, most powered versions let a tube-shaped motorized blade, inserted through a small hole in the abdomen, do the work. You Tube Videos show the blade cutting into the tissue, which is pulled up the tube in pieces. Doctors estimate between 55,000 and 75,000 women have morcellator-aided hysterectomies every year, sparing them longer incisions from open surgery and getting them back on their feet faster.
2 They pose a potential danger to a few.
Gynecologists saw from the beginning that morcellators can drop bits of tissue. They also knew that in rare cases, what looks like a fibroid can be a hidden cancer. A study in South Korea in 2011 turned heads at a medical conference by showing how morcellating these tumors, rather than removing them whole, was more likely to spread cancer and worsen survival rates. The issue went mainstream in December, with the well-publicizedcase of Amy Reed, a 41-year-old anesthesiologist. Boston’s Brigham and Women’s Hospital said that, by using morcellation, it inadvertently worsened the cancer of Dr. Reed, who has joined her doctor husband in lobbying for a moratorium on the procedure.
4 Many experts recommend alternatives.
According to many gynecologists, women can still reap the benefits from surgery with tiny incisions without the risks of morcellators. It's partly a matter of proper training on other techniques, ranging from cutting up masses with knives-and in bags-just under the surface of the skin, to using a procedure in which the uterus is removed intact through the vagina, they say. The American Congress of Obstetricians and Gynecologists recommends vaginal hysterectomies as having the best outcomes and least complications. The organization estimates that morcellation is necessary in 11% of vaginal hysterectomies, but doctors say this can be done manually, with simple cutting tools, and in bags. Temple University Hospital set three main ways doctors can perform hysterectomies for fibroids: When the uterus is small enough, it should be removed intact vaginally; when the uterus is much larger, the hospital wants open surgery; the hospital will allow morcellation in midsize cases, but only in bags.
5 Hospitals are moving to disclose more before surgery.
The morcellation debate has sparked another big change: Several hospitals, including Brigham, Temple and Massachusetts General, say they now require doctors for the first time to advise women about the cancer-spreading risk. This wasn't common before, even though medical ethicists suggest this was a bad enough potential outcome to warrant discussion. Cleveland Clinic and other leading institutions have said doctors should have been disclosing the risk. What women do with that information is up to them. But compared with a few months ago, they have a better chance to more fully weigh the benefits, but also the risks, of less invasive surgery.