Safety Update: Minimally Invasive GYN and Cancer Risk

Utilizing the safest techniques for gynecologic surgery may reduce cancer risk

Inova’s Centers of Excellence in Minimally Invasive Gynecologic Surgery are experienced in the most up-to-date and safest procedures. Inova Fair Oaks Hospital performs 96.7% of gynecologic procedures using a minimally invasive approach, which is a wonderful improvement in women’s health care.

Recent media attention has focused on a technique used in some of these surgeries called open electromechanical morcellation (open power morcellation) and the possible risk of spreading a very rare form of uterine cancer.  Power morcellation does not cause cancer and it could only spread a cancer that is already present if not contained. Loss of benign tissue fragments can also cause complications.  At Inova, patients who are candidates for minimally invasive gynecologic surgery (MIGS) are counseled about the benefits and risks of using this technique and undergo screening and consideration of risk factors to help rule out the presence of this rare cancer.

Addressing the News

Open power morcellation uses a device to cut the specimen into very small pieces without the use of a containment bag for removal through a small incision.  Incisions are usually ½ – ¾ of an inch, patients go home the same day and are usually back to work in one to two weeks.  This instrument may increase the risk of spreading undiagnosed cancer cells.  For this reason, in April, the FDA discouraged the use of open power morcellation.  The FDA held a two-day hearing on this issue with testimony from expert physicians, patients and industry.

Dr. Ray Wertheim, Co-Director, Minimally Invasive Gynecology at Inova Fair Oaks Hospital, was a member of the ten-physician American Association of Gynecologic Laparoscopy task force who reviewed this issue and released a comprehensive position paper.  “This issue is very complicated.  The conclusion of our review is that the power morcellator should not be banned.  Identified risk factors should be considered and appropriate testing be done before the surgery.  In addition, it is critical that good informed consent be done in language the patient can understand before consideration of using this instrument.  Lastly, we are encouraging industry to develop contained morcellation instruments to prevent loss of benign and malignant tissue fragments and are studying how to more accurately rule out the rare sarcoma with testing before the surgery.”

“Endometrial and cervical cancer can usually be diagnosed before surgery,” says Dr. Wertheim.  “However, uterine sarcoma, a rare cancer, cannot always be ruled out prior to surgery.  The Inova Fair Oaks Hospital Minimally Invasive Department recently sponsored a dinner conference for surgeons discussing tissue extraction without using open power morcellation and the safest MIGS techniques, such as contained morcellation instruments.”

Dr. Leonard Rosen, Medical Director, Women’s Services at Inova Fair Oaks Hospital adds, “Anyone considering gynecologic surgery should undergo a careful screening and review the risks and benefits of tissue morcellation prior to surgery so that continued minimally invasive procedures can be carried out safely, without returning to open laparotomy and the concomitant morbidity associated with that approach. Then, together with their doctor, they can make an informed decision about their treatment options.”