Review Article: Morcellator in Gynaecological Minimally Invasive Surgery-A Boon or a Curse?

The commonest gynecological surgery all over the globe in women of childbearing age is Hysterectomy performed commonly for leomyoma, a benign tumour of the uterus1. The credit for the first laparoscopic hysterectomy goes to Harry Reich in Kingston, Pennsylvania who performed it in the year 19882. The procedure gained wide popularity, as a specialized instrument called morcellator³ could suck large myomas and diseased uterus out, till the surfacing of the controversy on use of the morcellator. Studies showed that use of morcellator resulted in upstaging of a concealed uterine leiomyosarcoma, which cannot be diagnosed with certainty by any means preoperatively⁴, ⁵. This posed a question on the random use of the morcellator. The morcellator controversy came into lime light with the unfortunate upstaging of an unsuspected leiomyosarcoma of uterus, presumed to be due to intra-peritoneal seedling of the cancerous tissue by the use of a morcellator in the laparoscopic hysterectomy done on Dr Amy Reed, an anesthesiologist at Beth Israel Deaconess Medical Centre, Boston, USA⁴. Thus a stage I disease with 65% survival rate at 5 years was converted in her case into a stage IV disease with almost 85% mortality in 5 years⁴. She and her husband fought the legal battle banning the use of morcellator for long four years and Dr Reed succumbed to multiple recurrences of the upstaged cancer in her abdomen and lungs on 24th May 2017 at her home in Yardley⁶, ⁷. On further analysis of scientific literature by Michael Paasche-Orlow who was a colleague of Dr Reed's husband, the incidence of a concealed cancer uterus was recorded to be as high as 1 in 350 contrary to the earlier belief of 1 in 10, 000 cases⁶. Many more such incidences came to light prompting the USFDA to impose restrictions with cautious notifications though not a complete ban on the procedure of morcellation8. Similar actions by many medical institutions and hospitals were imposed, and several lawsuits by the affected patients followed worldwide⁴. In I dian scenario, the magnitude of the problem could be vast both due to a poor availability of statistical data and a poor post surgery follow up of the patients.