The Wall St Journal this week puts in perspective the dilemma the past decade of whether or not to have vaginal powertool uterine morcellation – mincing- as the less risky procedure for vaginal hysterectomy, as opposed to the oldfashioned open surgery. “Gynecologists Resist FDA Over Popular Surgical Tool Doctors Continue to Use Morcellators Months After Regulator Warned They Can Spread Undetected Cancer. These doctors say they believe the risks of unknown cancer have been overblown and the government shouldn’t interfere with patient treatment. ” Shades of overdiagnosis of breast and prostate cancer by mass screening of the well.
This lack of good evidence as to what is good best practice hasnt stopped lawyers like Weitz and Luxenberg from chasing lucrative compensation claims. Their mission statement says it all: “Weitz & Luxenberg is New York City’s largest personal injury and mass-tort plaintiffs’ law firm. Built on the philosophy that every client’s case is our most important, we have won more verdicts than most other U.S. law firms. Our goal is to set an unmatched standard of excellence for mass tort litigation — which is why, since our founding in 1986, our attorneys have relentlessly sought to deliver justice in cases involving asbestos and mesothelioma, defective drugs and medical devices, medical malpractice, general negligence, and environmental pollution, among others. We are unflinching in our belief that our clients deserve our absolute best work. ”
Vag hyst Morcellation studies show that it has ~40% shorter hospitalization time than total hysterectomy without morcellation because of almost 2/3 lower surgical risks. as Wiki says, hysterectomy Short term mortality (within 40 days of surgery) has been reported in the range of 1–6 cases per 1000 when performed for benign causes. Risks for surgical complications are presence of fibroids, younger age (vascular pelvis with higher bleeding risk and larger uterus), dysfunctional uterine bleeding and parity. The mortality rate is several times higher when performed in patients that are pregnant, have cancer or other complications.
so where hysterectomy is essential (it seldom is- but is fashionable for sporty women, lucrative for hospital staff),
its up to the woman to decide for herself with informed consent whether to risk the numerous complications of conventional hysterectomy/myomectomy- which with a big fibroid is high-
versus having morcellation, then awaiting the <1:300 likelihood of a positive pathology report that her fibroid contained LMS, and facing recall for chemo.
. So the first thing for those with growing breasts/lumps or fibroids are to eliminate, balance the excess estrogens. Dr Dee analyses this thoroughly at http://www.leiomyosarcoma.info/hormones.htm;
and Dr Mostovoy at http://www.thermographyclinic.com/hysterectomy. We do see breast and uterine fibroids turn around with such approach- but of course likely malignancies need to be typed by biopsy. .
Uterine leiomyosarcoma (ULMS) is identified in 0.1% to 0.2% of hysterectomy specimens of presumed leiomyoma. To date, there is no preoperative technique that reliably differentiates ULMS from uterine leiomyoma. Increasing use of minimally invasive approaches for the management of leiomyomas may result in inadvertently morcellated ULMS with resultant intraperitoneal dissemination of tumor. The objective of this study was to assess the impact of intraperitoneal morcellation on the outcomes of patients with ULMS. METHODS: In this retrospective cohort study, all patients with ULMS who attended the authors’ institutions from 2007 to 2012 were reviewed. Demographics and outcomes were compared between those who underwent morcellation or total abdominal hysterectomy (TAH) as their first surgery for uterus-limited ULMS. RESULTS:In total, 58 patients were identified, including 39 who underwent TAH and 19 who underwent intraperitoneal morcellation. Intraperitoneal morcellation was associated with a significantly increased risk of abdominal/pelvic recurrences (P = .001) and with significantly shorter median recurrence-free survival (10.8 months vs 39.6 months; P = .002). A multivariate adjusted model demonstrated a >3 times increased risk of recurrence associated with morcellation (hazard ratio, 3.18; 95% confidence interval, 1.5-6.8; P = .003). CONCLUSIONS: Intraperitoneal morcellation of presumed leiomyoma worsens the outcomes of women with ULMS. Because there are no reliable preoperative techniques to distinguish ULMS from benign leiomyoma, all efforts to minimize intraperitoneal uterine morcellation should be considered.