A 44-year-old woman with multiple uterine fibroids undergoes laparoscopic myomectomy. The surgeon considers using a power morcellator to remove the specimen. Which of the following is the most important counseling point regarding this technique?

• A It increases the risk of ureteric injury compared to vaginal extraction
• B It significantly increases the risk of uterine rupture in subsequent pregnancies
• C It is contraindicated in all patients over the age of 40
• D It may disseminate occult malignancy, including leiomyosarcoma, throughout the peritoneal cavity ✓

Explanation

The FDA and ACOG have issued warnings about power morcellation because it can disseminate occult malignancy, particularly unsuspected leiomyosarcoma, throughout the peritoneal cavity, upstaging the disease and worsening prognosis. This is the primary safety concern. In-bag morcellation and careful patient selection are now recommended. The risk of uterine rupture relates to the myomectomy itself, not the morcellation technique specifically.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.