Surgery

An analysis of minimally invasive hysterectomies performed at multiple institutions over a 7-year period shows that one in every 368 women who underwent morcellation had uterine cancer. According to the investigators, the study also reveals an association between advanced age and increasing prevalence of underlying cancer and endometrial hyperplasia in these patients.

Institutions around the country have responded to an FDA advisory by discouraging or banning power morcellation of uterine fibroids. Innovative methods of contained morcellation are now called for.

According to a new study in Cancer, the incidence of cervical cancer in older women may be higher than has been previously reported.

A safety communication discouraging use of power morcellation during hysterectomy or myomectomy for fibroids has been issued by the Food and Drug Administration (FDA) because of concern about risk of inadvertent spread of unsuspected cancer to abdominal and pelvic cavities.

Was there an unreasonable delay in making the diagnosis, and did that delay have an effect on the patient’s treatment and overall life expectancy?

Ovarian cancer is notorious for its late stage at diagnosis and its poor prognosis. In the absence of good screening tests, salpingectomy is the only form of prophylaxis for this cancer.

Gynecologic surgeons should give consideration to the balance of benefit and harm that accompanies laparoscopic tissue morcellation, in addition to exploring surgical alternatives and methods to mitigate complications.

Clear, consistent steps for each specific surgical procedure should be adopted so that team members can become familiar with each procedure with repetition. Procedural steps for a robotic hysterectomy are shown in the video.

Employing a separate 5-mm conventional laparoscope via the assistant port allows for safe placement of robotic ports and instruments under direct laparoscopic visualization. The robotic ports are generally placed such that they are in a straight line to minimize arms clashing. The ports are generally placed at the level of the umbilicus. They should, however, be adjusted cephalad, to accommodate complex surgical cases such as large fibroids, obese patients, or para-aortic lymph node dissection.

A commentary on ACOG Practice Bulletin Number 133: Benefits and risks of sterilization

Three surgeons discuss the pros and cons of the two methods.

Your guide to determining appropriate candidates and appropriate routes of hysterectomy for benign gynecologic conditions

Having a hysterectomy with or without ovary removal in mid-life does not increase a woman's risk of cardiovascular disease compared to women who reach natural menopause, contrary to many previously reported studies.

A large multiyear cohort study by investigators at ColumbiaUniversity in New York City shows limited short-term benefit and significantly higher cost for robotic-assisted hysterectomy than for laparoscopic hysterectomy. The findings, say the researchers, point to the need for “rational strategies to implement new surgical technologies.”

First know the anatomy and the risk factors, but don't forget to screen for and recognize injury as well.