Assessing the risk of laparoscopic morcellation of occult uterine sarcomas during hysterectomy and myomectomy: Literature review and the ISGE recommendations
| Autor: | Ornella Sizzi, Lucia Manganaro, Robert K. Zurawin, Alessandro Loddo, Giuseppe Florio, Matteo Saldari, Alfonso Rossetti, Bruno van Herendael, D. Djokovic |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Uterine fibroids medicine.medical_treatment Uterine leiomyoma MEDLINE Morcellation Hysterectomy Risk Assessment 03 medical and health sciences Power morcellation Preoperative assessment Uterine leiomyosarcoma Reproductive Medicine Obstetrics and Gynecology 0302 clinical medicine Uterine Myomectomy medicine Humans Gynecological surgery 030219 obstetrics & reproductive medicine Leiomyoma Uterine sarcoma business.industry General surgery Sarcoma Evidence-based medicine medicine.disease Surgery 030220 oncology & carcinogenesis Uterine Neoplasms Female Risk assessment business |
| Popis: | Objective This project of the International Society for Gynecologic Endoscopy (ISGE) had the objective to review the literature and provide recommendations on the occult sarcoma risk assessment in patients who are candidates for minimally invasive gynecological surgery involving intra-abdominal electromechanical tissue morcellation. Study design The ISGE Task Force for Estimation of the Risk in Endoscopic Morcellation initially defined key topics and clinical questions which may guide a comprehensive preoperative patient assessment. A literature search within the Medline/PubMed and Cochrane Database was carried out using keywords “morcellation”, “uterine fibroids”, “uterine sarcoma”, “myomectomy” and “hysterectomy”. Relevant publications (original studies, meta-analyses and previous reviews), written in English and published until May 30th, 2017, were selected and analyzed. Previously emitted statements of 12 recognized professional societies or government institutions and their supporting literature were also studied. For each topic/clinical question, the available information was graded by the level of evidence. The ISGE recommendations were established in accordance with the evidence quality. Results In the light of available information, 9 recommendations on preoperative clinical, laboratorial and imaging evaluation of the candidates for intracorporeal uterus/leiomyoma morcellation were formulated, mainly based on consensus and expert opinions. There is a lack of high-quality evidence, which does not allow the establishment of strong recommendations. Conclusion Electromechanical tissue morcellation may be used in gynecological patients who are considered “low risk” upon appropriate preoperative evaluation; however, further studies and prospective data collection are greatly needed to improve sarcoma risk assessment in women with presumed uterine leiomyomas. |
| Databáze: | OpenAIRE |
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