The sweeping nature of the recent FDA advisory recommending that the use of morcellators for hysterectomies be discontinued or severely restricted is both surprising and disappointing, to say the least. To those of us who are experienced in laparoscopic minimally invasive surgery — those of us who've witnessed its tremendous benefits firsthand — this feels like a rush to judgment.
Morcellators — powered instruments that can be inserted through small ports in the abdominal wall in the course of laparoscopic hysterectomies or myomectomies — let us break up large pieces of tissue so that they can be safely removed without large abdominal wall laparotomy incisions or large incisions in the apex of the vaginal vault.
My group, Walnut Hill OB/GYN Associates, practicing at the Texas Health Women's Specialty Surgery Center of Dallas, has performed more than 2,000 laparoscopic supracervical hysterectomies (LSH) and we've had zero issues with morcellation. There have been no adverse incidents or injuries to bowels, bladders or blood vessels of surrounding pelvic organs, nor have we discovered a single unsuspected uterine sarcoma.
By contrast, open-incision laparotomy, which will dramatically increase as a result of this advisory, has been proven to increase the risk of infection, blood loss, and collateral injury to the ureter, bladder and bowel, as well as death due to post-operative complications, including DVT and pulmonary embolus. It will increase the length of hospital stays, as well, and on the order of 4- to 20-fold. Many minimally invasive surgeons haven't had to keep a patient overnight after an LSH in years. Before the introduction of the morcellator, all patients stayed overnight.
It's worth noting that as gynecologic surgeons, we have no financial incentive to defend the use of morcellators. The fact is, open cases almost always provide significantly better compensation. But we do have a commitment to provide our patients with the best and safest care. This advisory has the potential to severely limit our ability to do that.