Doctors Share Closed Morcellation Techniques that Reduce Cancer Risk

In April 2014, the FDA warned about the cancer risks associated with using power morcellation in uterine fibroid removal and hysterectomy procedures. Since then, many doctors have shied away from the technique, while a number of hospitals have stopped using the devices.

Rather than completely ban the procedure, however—which relegates many women to more invasive surgeries with longer incisions and increased scarring—a few doctors have suggested using a morcellator bag to capture all tissues during the procedure. There has been debate on this suggestion, with some surgeons noting that such bags can be difficult and unwieldy to use.

Now, in a new report in ObGyn News, doctors Tony Shibley, Bernard Taylor, and Ceana Nezhat provide detailed instructions on how using a surgical bag with a power morcellator can help prevent any spread of cancerous tissues during gynecological surgery.

Doctor Describes Closed Morcellation Technique

Power morcellators are surgical tools that allow doctors to cut up larger tissues for removal through small incisions. They have proven to be beneficial in gynecological procedures, as they allow for minimally invasive surgery, a reduced risk of infection, and a faster recovery. Recent studies, however, have shown that in rare cases, the morcellator can leave bits of cancerous tissues behind, where they can spread to re-seed other cancers in the body.

Use of power morcellation without a bag is called “open” morcellation, and has been the preferred method of surgery for years. Shibley recommends a method that uses a surgical bag, however, called “closed morcellation,” which he says he’s been performing for over two years now.

“This meets the needs of containment while significantly lowering the risk of tissue dissemination,” he writes, “and also reducing the risk of bowel injury, vascular injury, and other types of morcellator-related mechanical injuries. This approach to morcellation is safer on all fronts.”

Shibley describes his technique, and adds that he’s designed a special bag that opens automatically, to assist in catching the specimen, and has closure tabs and a retrieval lanyard. The product is now pending FDA approval, after which it will be manufactured by Advanced Surgical Concepts.

Proficient Surgeons can Save Time with Bag Technique

Dr. Taylor acknowledges that cancer risk is now one of the main concerns of both surgeons and patients, he developed his closed morcellation technique primarily to “perform as complete an extraction as possible.”

Surgeons may question the extra time it takes to place the bag where it needs to be, but Taylor states that once a doctor has learned the technique, the difference in the time needed to complete the surgery is negligible. “In fact,” he writes, “cases may be shorter because of the time saved by not having to retrieve uterine fragments from the abdomen and pelvis.”

Removing Larger Tissues Presents More Challenges

Removing uterine fibroids and removing an entire uterus obviously require different techniques. Dr. Nezhat notes that removing larger tissues with minimally invasive surgery techniques can be challenging. Removal through the vagina is still the preferred method, but the morcellation required can leave potentially cancerous tissues to spread to other areas of the body. Again, Nezhat recommends using a specimen bag to collect the tissues, in a procedure called “enclosed vaginal morcellation.”

Women who have suffered advanced cancers because of morcellation procedures may be eligible to file lawsuits against the manufacturers of the devices. Meanwhile, gynecological surgeons are busy addressing the issue, looking for new and improved techniques that will lower the risk.