Dangers for Removing Fibroids – the morcelator

morcelatorJennifer Levits reported in the Wall Street Journal 12/18/13 “Doctors Eye Cancer Risk in Uterine Procedure“.  She recounted the story of Dr. Amy Reed who had a hysterectomy.  The uterus contained fibroids and the fibroids contained cancer.  The procedure was done with an instrument, the morcelator.  In kitchen terms it is a combination blender and vacuum cleaner.  It is used during laproscopic surgery to chop up things (like a uterus with fibroids) and remove them through a small incision in the abdomen.

The problem is the morcelator does not remove all the tissue.  A few cells escape the vacuum and they are left behind in the abdomen.  If those cells contain cancer the cancer is then planted in the abdomen later to grow and likely kill the patient.  Dr. Reed developed the seeding of cancer and claims other procedures would be better.  Traditional surgery removes the uterus and fibroids intact with less chance of spreading any unsuspected cancer.

Here is what the package insert that comes with the morcelator says:

CAUTION: … use of the …  Morcellator may lead to dissemination of malignant tissue.

So what are the statistics?

  • 20% – 40% of women will develop fibroids
  • 1 in 1000 cases of fibroids contain cancer
  • intact removal of fibroids with malignancy failed to stop the malignancy 19% of the time
  • morcelator removal of fibroids with malignancy failed to stop the malignancy 44% of the time

The big question is:  should a morcelator be used if a woman has fibroids because it may double the risk of spreading an unsuspected cancer?

The simple answer is NO, because there are other surgical options.  But, will women accept that answer?  The laprosocopic procedure has less pain and quicker recovery, so the answer turns out not to be so simple.  There are many forces at work on the decision to continue to use the morcelator.   The analysis of these forces is called force-field analysis which was originally described by social scientist Kurt Lewin in the 1940’s.     The following is such an analysis (the rating of force vectors is by the author of this blog):

Morcelator Analysis

So, what will happen?  It seems at this point the morcelator will continue to be used.  But, the risk remains.  Law suits will continue.  Perhaps a safer device will be developed.  Perhaps a high risk of litigation will be perceived by gynecologists and the malpractice insurance companies as  being too great.  Such risk will lower the forces from doctors and perhaps tip the balance.  Time will tell.

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Update (8/1/14):  since the original post the FDA issued a warning about morcelators.  Yesterday, Johnson & Johnson, the major supplier, stopped selling morcelators.  Looks like the forces to abandon the morcelator have been joined by the FDA and the manufacturer.

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Update (2/27/15):  yesterday the Wall Street Journal reported United Health (insurance) requires surgeons to obtain permission for procedures that might use the morcelator — “another blow” to the device.  At this point any surgeon using the device must feel like they are walking a tightrope without a net.

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  1. #1 by Chuck Schauberger on December 22, 2013 - 6:00 AM

    When faced with an argument, the first thing physicians tend to do is question the statistics. This will be true of my response. I think the prevalence of fibroids is higher than 20-40%. As a cause for hysterectomy, it is the most common reason. The rate of leiomyosarcomas seems much lower than 1/1000. I recall only taking care of several women with this tumor over the course of my career, and it seemed like the presentation demonstrated a pattern that suggested that an open case was necessary.
    Disclaimer: I used morcellators when I did laparoscopic hysts in the past. I don’t do major surgery anymore. It was fun to use! Add that as a force in your field analysis!

    • #2 by qualityhealthcareplease on December 22, 2013 - 11:25 AM

      Thanks for the thoughtful comment. The WSJ statistics for leiomyosarcoma make it seem common but in the real world it is very uncommon. We should not stop medical innovation in an effort to be perfect and avoid every single complication. But, sometimes a little tweak to a device or invention might save the lives of a few of those who do suffer bad complications, like the spread of cancer. Legal action sometimes has a paralyzing effect — a change in a product might appear to be an admission of guilt. It would sure make patients feel better if the company that makes morcelators would step forward and say — hey, we can improve this device by … and we already made the changes! Or perhaps a competitor will make a better product so they can say the problem is solved. Clearly, making the problem public is a step in the right direction.

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