By Alice Goodman
NEW YORK – More than a year after the Food and Drug Administration first warned physicians and patients about the risks of disseminating unsuspected cancer with electric power morcellation, most minimally invasive gynecologic surgeons are not using the technology.
But rather than convert to open laparotomy for fibroid removal, many surgeons are using conventional and robotic-assisted laparoscopic techniques, Dr. Farr Nezhat said at the annual Minimally Invasive Surgery Week.
“The controversy over electric power morcellation demonstrates the difficulty with surgical innovation. The risks and balances of morcellation must be balanced. The current debate demonstrates the power of public opinion,” said Dr. Nezhat, who is director of minimally invasive surgery and gynecologic robotics at Mount Sinai Roosevelt and Mount Sinai St. Luke’s hospitals, New York. “The good news is that the majority of respondents have not converted to laparotomy.”
Dr. Nezhat and his colleagues sent a survey to 3,505 members of the Society of Laparoendoscopic Surgeons and received 518 responses. Surgeons were queried on their beliefs about morcellation and current practices for fibroid removal.
Sixty-one percent of respondents said they do not currently use a power morcellator. Of those who do not use the device, nearly half said it was because power morcellation was banned by their hospital, while others responded that they were not comfortable using it or that their hospital didn’t have power morcellation equipment.
A total of 60% said they believe morcellation affects survival, and 66% said that morcellation also disseminates benign pathology. Additionally, 48% reported that they have encountered a diagnosis of unsuspected uterine carcinoma in their practices.
So what are surgeons doing instead of power morcellation? About three-quarters of respondents currently perform open laparotomy in fewer than 25% of their cases. Their responses indicated that they mostly use laparoscopic and robotic procedures.
“It is encouraging that they did not go back to open laparotomy and that they have obviously found alternatives,” Dr. Nezhat said at the meeting sponsored by the Society of Laparoendoscopic Surgeons and affiliated societies.
Dr. Nezhat and his colleagues are planning a second survey to get details on the type of approaches that ob.gyns. are now using: vaginal morcellation, minilaparoscopy, or posterior colostomy, as well as and whether they perform morcellation in a bag.
“I have stopped using electric morcellation, and now we use a bag,” he said.
Dr. Nezhat reported having no relevant financial disclosures.
Source: Ob.Gyn. News