A Retrospective Analysis About Morcellation Applied To Unexpected Uterine Sarcoma

Background and objective Uterine leiomyoma is the most common benign neoplasm of female genital organ which always occur in women of childbearing age.Surgery is still the main treatment for some patients who have significant clinical symptoms。With the development of social and medical technology,the quality of people’s life improves,more and more patients will choose myomectomy.Compared with the conventional laparotomic myomectomy,laparoscopic myomectomy has some advantages including less pain and reduced blood loss,faster recovery,and fewer complications.Power morcellator can further prevent the need to enlarge established incisions and shorter operating time.But there are also serious drawbacks.However there are many literature have been reported that laparoscopic power morcellation is performed in women with unsuspected uterine sarcoma in recent years,The laparoscopic power morcellation has a risk to spread the cancerous tissue within the abdomen and pelvis,significantly worsening the patient’s procedure andlong-term survival.For this reason,and because there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma,The Food and Drug Administration(FDA)issued a press release in April 2014 that discouraged the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.At present,China does not prohibit the use of laparoscopic power morcellation,and there is no unified international clinical guidelines,Through the retrospective analysis of the cases of laparoscopic surgery for uterine fibroids,a study providing a reference for clinicians was done to investigate the ratio of laparoscopic morcellator is performed with unsuspected uterine sarcoma and its influence on prognosis.Methods:(1)593 cases underwent myomectomy in First Affiliated Hospital of Da Lian Medical University from Jan.2010 to Dec.2015 were collected,and their preoperative diagnosis was benign Benign uterine leiomyoma.According to the Surgical approach,they were divided into two groups,laparoscopic group(181 cases)and laparotomy group(412 cases),Compare the two groups ’ratio of unsuspected uterine sarcoma and retrospective analysis of clinical data and prognosis,4 cases accepted the second operation for the reason of laparoscopic power morcellation is performed in the 4 cases with unsuspected uterine sarcoma in the first operation in First Affiliated Hospital of Da Lian Medical University from Jan.2010 to Dec.2015 were collected and retrospective analysis of clinical data and prognosis,Analyzing four patients clinical data and prognosis.Results:(1)There were 1 cases of unexpected uterine sarcoma inlaparoscopic group,and the ratio was0.55%.6 unexpected uterine sarcoma occurred laparotomy group,,and the ratio was 1.46%.There was no statistical difference in the ratio betweenthe two groups(P = 0.599).Two groupspatients accepted the second operation have no cancerous tissue within the abdomen and pelvis until now.(2)1 case(25%)accepted the second operation for recurrence of cancerous tissue within the abdomen,pelvis and peritoneum after 3 month,died of malignant clinical outcomes after 19 days.The rest of the cases were follow-up without recurrence or death.Conclusion :1.The opportunity of laparoscopic power morcellation performed in uterine sarcoma is very rare.However,there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis,significantly worsening the patient’s likelihood of long-term survival.2.Strengthen the preoperative evaluation:(1)<40 years,diameter<8 cm,slower growth,radiological and laboratory examinations are all normal,allowing the use of morcellator;(2)>40 years and not menopausal patients,any of above-mentioned examinations are abnomal,not recommend using morcellator;(3)Menopausal patients do not recommend using morcellator.3.Patients will benefit from the second surgery as soon as possible.The development of safer morcellation techniques in the abdominal cavity by technical improment,including in-bag morcellation,is in its infancy.