Abstract
Objective
This project of the International Society for Gynecologic Endoscopy (ISGE) had the
objective to review the literature and provide recommendations on the occult sarcoma
risk assessment in patients who are candidates for minimally invasive gynecological
surgery involving intra-abdominal electromechanical tissue morcellation.
Study design
The ISGE Task Force for Estimation of the Risk in Endoscopic Morcellation initially
defined key topics and clinical questions which may guide a comprehensive preoperative
patient assessment. A literature search within the Medline/PubMed and Cochrane Database
was carried out using keywords “morcellation”, “uterine fibroids”, “uterine sarcoma”,
“myomectomy” and “hysterectomy”. Relevant publications (original studies, meta-analyses
and previous reviews), written in English and published until May 30th, 2017, were
selected and analyzed. Previously emitted statements of 12 recognized professional
societies or government institutions and their supporting literature were also studied.
For each topic/clinical question, the available information was graded by the level
of evidence. The ISGE recommendations were established in accordance with the evidence
quality.
Results
In the light of available information, 9 recommendations on preoperative clinical,
laboratorial and imaging evaluation of the candidates for intracorporeal uterus/leiomyoma
morcellation were formulated, mainly based on consensus and expert opinions. There
is a lack of high-quality evidence, which does not allow the establishment of strong
recommendations.
Conclusion
Electromechanical tissue morcellation may be used in gynecological patients who are
considered “low risk” upon appropriate preoperative evaluation; however, further studies
and prospective data collection are greatly needed to improve sarcoma risk assessment
in women with presumed uterine leiomyomas.
Keywords
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Article info
Publication history
Published online: November 06, 2017
Accepted:
October 30,
2017
Received in revised form:
October 16,
2017
Received:
June 10,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
