The jury may still be out on whether banning the use of power morcellation in minimally invasive hysterectomies would help or harm more women in the long run, but a large hospital chain and a major insurer aren't waiting to find out.
The University of Pittsburgh Medical Center has announced that it will suspend use of the procedure, which was the subject of an FDA advisory in the spring and the focus of continued FDA scrutiny in hearings held this summer. Meanwhile, insurer Highmark, Inc., one of the largest Blue Cross Blue Shield plan providers in the country, has announced that it will stop paying for the procedure after Sept. 1.
The controversy centers on the effect that power morcellation has on hidden sarcoma, a rare and largely undetectable form of uterine cancer. Morcellation, which breaks the uterus into small pieces that can be extracted laparoscopically, is likely to upstage the disease in women with undetected cancer.
However, estimates vary dramatically as to the number of women who have hidden sarcomas, with opposing extremes estimating as many as 1 in 350 and as few as 1 in every 6,400. Additionally, proponents of morcellation point out that open surgery is associated with much higher rates of morbidity and mortality; they further argue that prospects for women with hidden sarcomas are already grim.
Jason Wright, MD, director of gynecologic oncology at the Columbia University Medical Center in N.Y., and the lead author of an influential study recently published in the Journal of the American Medical Association, tells Outpatient Surgery Magazine that objective data on the pros and cons of morcellation is severely lacking and that the risks need to be quantified.