Laparoscopic power morcellators assist doctors in performing uterine surgeries. There is mounting evidence showing that power morcellators worsen the life expectancy of women with undetected cancer.
What Are Power Morcellators?
Gynecologists use power morcellators to remove uterine fibroids. Morcellators are handheld devices with long, hollow cylinders. The end of the cylinder has sharp edges or jaws that cut away fibroids and pieces of tissue to be extracted. The fibroids are vacuumed out of the abdomen through the cylinder.
Uterine fibroids, also called leiomyomas, are growths that develop from the muscle tissue of the uterus. Gynecologists can remove these fibroids individually (myomectomy) or remove all or part of the uterus (hysterectomy). Approximately 75 percent of women develop a uterine fibroid at some point in their lives.
The largest producer of power morcellators was Ethicon, a subsidiary of Johnson & Johnson, before the company suspended sales of the devices in 2014. Power morcellators developed by Ethicon include:
- Gynecare Morcellex Tissue Morcellator
- Morcellex Sigma Tissue Morcellator System
- Gynecare X-Tract Tissue Morcellator
The first power morcellators were used in the early 90’s for uterine extraction. It wasn’t until 2014 that the Food and Drug Administration (FDA) issued a warning that these devices can spread cancer in women having fibroids removed.
Most uterine fibroids are noncancerous, but some host cancerous cells. Doctors test for cancer before performing a hysterectomy or myomectomy, but uterine cancer is hard to detect. If an undetected cancer exists, a power morcellator can spread the cancerous material, making it harder to treat.
How do Power Morcellators work?
Power morcellators became popular because doctors could minimize complications and recovery time after a hysterectomy.
Laparoscopic surgeries, like those involving a power morcellator, are procedures that use a camera to see inside the abdomen.
In a laparoscopic hysterectomy, a surgeon inserts the cylinder of the morcellator into the abdomen through a small “keyhole” incision to remove uterine fibroids and part or all of the uterus. Through another incision, the surgeon inserts a small camera to guide the morcellator to the fibroids.
Before morcellators, surgeons had to make large, three-to-seven inch incisions to remove see inside the abdomen. They would remove the uterus or the fibroids intact. These surgeries required a longer recovery time and left larger scars, which contributed to laparoscopic morcellators being a more attractive option. However, a hysterectomy that doesn’t require a power morcellator won’t spread cancer in the abdomen because the fibroids aren’t broken up inside the body.
Power Morcellator Side Effects
Although power morcellators are used in surgery to help prevent cancers, they have been shown to spread and worsen cancer in some cases. Some of the other potential side effects from power morcellators include:
- Bowel obstruction
- Spread of potentially cancerous fibroids
- Pelvic or abdominal pain
- Uterine cancer
Who Is At Risk?
Any woman who undergoes a hysterectomy or myomectomy with a power morcellator could be at risk of spreading an undetected cancer. Those who are most at risk of this happening are those most likely to have cancerous fibroids. Some of the risk factors of developing uterine cancer include:
Age – Older women are more likely to develop uterine cancer.
Race – For unknown reasons, African American women are more likely than women of other races to develop cancer.
Genetics – Women born with a specific abnormal gene are more likely to develop leiomyosarcoma.
Radiation – Woman who had pelvic radiation to treat cancer can sometimes develop a second uterine cancer because the radiation can mutate healthy uterine cells.
Evidence of Power Morcellator Complications
Although they have reduced surgical recovery times for many patients, morcellators can spread cancer throughout the abdomen and pelvis. During a hysterectomy with a morcellator, the device breaks up the uterus, releasing cancerous cells. Women with undetected cancer that have surgery involving a power morcellator are likely to receive a worse prognosis than if they had a traditional hysterectomy.
Even after extensive testing, uterine cancer can go undetected. There have been cases of women with cancer that MRIs, ultrasound and biopsies that failed to detect. It wasn’t until after surgery that cancer was discovered.
The FDA discouraged the use of power morcellators because of the risk of worsening undetected uterine cancer, including an aggressive disease called leiomyosarcoma.
If a morcellator spreads this type of cancer, the patient’s survival time is greatly reduced. What was once a potentially manageable disease becomes much harder to treat.
According to the American Cancer Society, the five-year survival rate for localized leiomyosarcoma is 63 percent. This means 63 percent of women with this diagnosis live up to five years. When leiomyosarcoma spreads through the abdomen, the five-year survival rate drops to 36 percent.
Last Edited: October 31, 2017
- Mayo Clinic Staff. (2016). Uterine fibroids. July 2016. http://www.mayoclinic.org/diseases-conditions/uterine-fibroids/basics/definition/con-20037901
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