The Dilemma of Myomectomy, Morcellation, and the Demand for Reliable Metrics on Surgical Quality | Minimally Invasive Surgery | JAMA Oncology | JAMA Network
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Invited Commentary
April 2015

The Dilemma of Myomectomy, Morcellation, and the Demand for Reliable Metrics on Surgical Quality

Author Affiliations
  • 1Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, Atlanta, Georgia
JAMA Oncol. 2015;1(1):78-79. doi:10.1001/jamaoncol.2014.184

In late 2013, a public awareness campaign was initiated after electromechanical morcellation (EMM) of a uterus with presumed benign leiomyoma, which in fact was leiomyosarcoma (LMS). Over the past year, the focus of the medical community has been on the incidence of occult LMS, specifically related to EMM. The risk of intracorporeal tissue dissemination by EMM resulted in some manufacturers halting sales of the EMM device, various hospitals banning the procedure, and ultimately a black box warning from the US Food and Drug Administration (FDA) for electromechanical morcellators.1

This type of issue is not new in medicine. In the 1950s and early 1960s, laparoscopic surgery was banned in Germany owing to electrosurgical complications during laparoscopic sterilization.2 This led to greater understanding of sparking, capacitation, and coupling related to electrosurgery during laparoscopy; subsequent technological improvements and surgeon education resulted in electrosurgery being an integral part of minimally invasive surgery today. Albert Einstein defined insanity as doing the same thing over and over again and expecting different results. As with electrosurgery, EMM needs reassessment and improvement in technique and instrumentation for proper use.

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