This is a little bit of a rehash from my previous posts but here goes:
Recent case in Boston hospital resulted in upstaging of a uterine sarcoma that was removed laparoscopically using a power morcellator. Patient was a physician herself and husband a cardio thoracic surg. Keep in mind, sarcomas of uterus are bad actors and have poor prognosis
; they are also rare ( fortunately) and are difficult to diagnose preop- no great tumor marker either.
When morcellating the uterus, or fibroids for that matter,to remove laparoscopically, microscopic pieces of uterus can seed the peritoneal cavity- this theoretically will upstage a cancer as it will disseminate the microscopic cancerous tissue thereby making it more difficult to treat.
This single case created a sh** storm and the FDA came out with warnings; subsequently ACOG (American college OB/GYN) came out with opinion statement recommending complete discussion and consent with pt prior to morcellating. JNJ who makes gynecare morcellator pulled it from all hospitals- can't be bothered with litigation; other vendors are still manuf last I checked. Some hospitals in boston placed moritorium on morcellating in general.
Before we get ahead of ourselves, this is a knee jerk response by FDA as we don't have a randomized control trial looking at risk of uterine sarcoma. The numbers bantered about regarding incidence are debated. In my practice of 4 board certified OB/GYN's with over 80 years clinical experience combined , we could only come up with single digit numbers of pts dx with uterine sarcoma.
Cut to the chase- how does this impact Sport- well 1st the initial target is gall bladders however one could perform hysterectomy or myomectomy with sport- myomectomy( removal of fibroids( leiomyoma) would be more difficult without third arm for countertraction but a 5 mm assist port could be used if need be); as far as removal if pt declined morcellation the following are options: mini laparotomy ( 3-4cm ) supra pubic incision to remove; posterior colpotomy( incision at cervical vaginal junction to remove and quick repair; enclosed morcellator with self contained bag - which is being trialed; or maybe we come to our senses and realize what we've been doing over 15yrs is reasonable along with appropriate consent.
As aside the symphion is a hysteroscopic device to remove intrauterine fibroids or polyps using RF. I use Tru Clear or Myosure or wire loop hysteroscopic resection as I was trained to do years ago.
Sport is NOT a hysteroscopic tool- we have dedicated hysteroscopes for those procedures- instrumentation is truly microscopic- maybe 3-5x LESS the size of robotic instruments and we use saline as a distending media in the uterine cavity to visualize and operate.
Ultimately, I still maintain as long as we hit our marks/milestones, this technology will succeed. Robotics is still in its infancy and like every other technology I have used over 20 years in the OR, the envelope continues to be pushed forward.
Ask any surgical specialist how current OR technology differs from when they were in residency training and I would bet anything it's markedly improved over even that short span of time.
