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Physician Groups Defend Morcellation for Some Women

Physician Groups Defend Morcellation for Some Women

May 12, 2014 — Two professional groups for gynecologists are defending a controversial technique used in hysterectomies and fibroid surgery, saying that the method is a useful option for some women, the Wall Street Journal reports (Kamp, Wall Street Journal, 5/9).

Background

The technique -- called laparoscopic power morcellation -- was developed as an alternative to invasive surgery for women with symptomatic uterine fibroids, which are responsible for about 40% of the 500,000 hysterectomies performed each year in the U.S. It uses a power device to grind uterine tissue so it can be removed through a tiny incision.

The technique has come under fire for its potential to spread a type of cancer -- known as a uterine sarcoma -- within the body.

In April, FDA issued a safety communication notice discouraging the use of the procedure. FDA in the notice said that uterine sarcoma affects about one in 350 women undergoing fibroid removal procedures and that laparoscopic power morcellation could significantly worsen the chances of long-term survival (Women's Health Policy Report, 4/21).

According to the Journal, several large hospitals have halted use of the technique, and Johnson & Johnson -- the largest manufacturer of the power tool -- recently suspended global sales (Kamp, Wall Street Journal, 5/8).

Groups Weigh In

On Friday, the American College of Obstetricians and Gynecologists released recommendations stating that the benefits of minimally invasive surgery must be balanced with the potential cancer risk from power morcellators, which are often used in such procedures.

ACOG said that while power morcellators can spread undetected cancer and worsen its effects, the data are limited and the cancer is rare, which makes the risk hard to quantify. The group said doctors should not use power morcellation in women with known or suspected cancers, although the cancer at issue cannot always be detected before surgery. Physicians should advise patients of the risk and benefits of their various options, ACOG said.

ACOG's recommendations came shortly after similar guidance from AAGL, formerly known as the American Association of Gynecologic Laparoscopists (Wall Street Journal, 5/9).

AAGL said that the use of power morcellators should be avoided in older women but that the technique can be a safe method for hysterectomies and fibroid removal in other women.

Specifically, the organization recommended that physicians consider alternatives for post-menopausal women, who have heightened cancer risks. In other women, AAGL said morcellation should only be used if there is a low cancer risk and initial tests suggest that growths are benign (Wall Street Journal, 5/8).

Impact of Recommendations

ACOG, with 58,000 members, is influential among doctors, hospitals and insurers in setting policies, according to the Journal.

The group's position puts it "somewhat at odds" with FDA, which plans to consider the issue further at a meeting this summer (Wall Street Journal, 5/9).