J Gynecol Oncol | Volume 2, Issue 3 | Research Article | Open Access
Michael Shu1*, Kenneth Fan2 and Abeer Eddib3
1Department of Obstetrics and Gynecology, University at Buffalo, USA 2Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Millard Fillmore Suburban Hospital, USA 3Minimally Invasive Advanced Pelvic Floor Surgery Fellowship, Western New York Urology Associates, USA
*Correspondance to: Michael Kee-Ming Shu
Fulltext PDFObjective: Uterine power morcellation has been under scrutiny following statements by the Food and Drug Administration (FDA) concerning dissemination of a possible occult malignancy. The impact of these warnings on women with pelvic organ prolapse and low suspicion for malignancy are not well documented in the medical literature. This study aims to compare the perioperative outcomes of patients undergoing Robotic-Assisted Sacrocolpopexies with Supracervical Hysterectomies (R-ASCP+SCH) by mechanical vs. manual morcellation. Methods: Cases of R-ASCP+SCH with contained manual morcellation were compared to controls using mechanical power morcellation. The primary outcome is operative time (minutes) from robotic patient cart undocking to the end of the surgical case and total narcotic medication requirements as measured by Morphine Milligram Equivalents (MME). Secondary outcomes assessed included estimated blood loss (cc), recovery time in the PACU (minutes), length of stay (days), incidence of malignancy on surgical pathology report, and percentage of patients who return for evaluation of post-operative complications. Results: A total of 162 women were identified. Cases of manual morcellation (n=131) were compared to mechanical morcellation controls (n=31). A total of 5 cases of malignancy were identified. Cases required approximately 9 additional minutes of operative time (49.5 min vs. 40.3 min, p<0.05). Cases additionally required more narcotic medications during recovery compared to controls (24.9 MME vs. 15.3 MME, p<0.05). The estimated blood loss, length of stay, and percentage of patients with post-operative wound complications were not statistically different. Conclusion: Uterine malignancy may be found in asymptomatic postmenopausal women presenting for pelvic organ prolapse repair. Manual morcellation during pelvic organ prolapse repair is a safe and effective approach without increased operative morbidity or complications.
Shu M, Fan K, Eddib A. Impact of FDA Power Morcellation Ban on Perioperative Outcomes for Robotic Sacrocolpopexy. J Gynecol Oncol. 2019; 2(3): 1017.