During a laparoscopic or robotic surgery, a surgeon uses very small incisions to insert cameras and working instruments. Laparoscopic surgery has been around for more than 25 years and is performed for common surgeries such as gallbladders, prostates, etc. It has also been used for hysterectomy and myomectomy. The challenge with these two procedures is that the organ that is being removed is much larger than the incisions themselves.
So what do we do?!? In comes the ‘morcellator’:
This fancy little device is used at the end of the surgery to break the uterus or the fibroid up into little pieces small enough to remove through the little laparoscopic holes which are made for the surgery. Without the morcellator, the surgeon would have to make an incision at least as large as the uterus or fibroid to remove it which would defeat the purpose of minimally invasive surgery.
The risk which has come to light with the use of the morcellator is in the very rare times when there is an unknown cancer inside a uterus or fibroid. By using the morcellator, that very small cancer can be broken up into many microscopic pieces which are spread throughout the abdominal cavity. Months or years later a women will develop metastatic (it’s spread) uterine cancer despite having had a hysterectomy.
Thus, the FDA has advised against use of the morcellator during Gyn surgery for this very reason. The Wall Street Journal published this article yesterday discussing the situation. More to come…. stay tuned as I’m sure this will evolve over the next months.