No morcellation
Saturday March 22nd 2014, 11:13 pm
Filed under: Family,Life,Non-Knitting

Stumbled across an article in the New York Times vitally, and I use that word literally, important to women dealing with potential surgery for fibroids or more.

There are quite a few comments there by Hooman Noorchashm, the doctor who started the raising of the alarm. He is facing losing his 41-year-old wife, also a doctor, the mother of their six children, because her OB/GYN did what has become a standard surgery in that specialty: laparoscopy with morcellation of the fibroid. Far faster recovery, tiny little scar, back to work much sooner, what’s not to love.

But.

Dr. Noorchashm, a surgeon himself, points out that morcellation is not done by any other surgeons in any other specialty–and for good reason: it not only breaks up the offending tissue and sucks it out, but it also spews it widely within the abdomen, and if there is any cancer lurking in those cells it’s suddenly everywhere and in the bloodstream.

Which is what happened to his wife. Her fibroids could have been removed intact and sent to pathology and instead she was suddenly an instant Stage IV leiomyosarcoma patient.

Leiomyosarcoma, he points out, is incurable and a fast death.

It is also what my mother-in-law died of a year ago. She was told that maybe when they did her hysterectomy years ago they missed a few cells which turned into ovarian cancer, but they found that that wasn’t quite what she had.

Going by the commenters on that article, it is believed in the leiomyosarcoma community that that misdiagnosis as ovarian accounts for quite a few of the cases of what MomH had, which our family was told was a highly rare disease.

Maybe not so much. Dr. Noorchashm says it’s one in 400 to 1000 of the fibroid cases that go to surgery and that every one of those cases could be treated by intact removal. Or have it go like his wife’s case. The cells might lay dormant for years and then suddenly go wild or they might get right to it, but either way it is not treatable at that point and invariably fatal. He is agitating, with good cause, for morcellation to simply cease to be done. Size of incision is not the purpose of surgery, he points out.

There’s a lot more in there about the economics of the device manufacturers and of some hospitals’ requirements that doctors do so many to keep their privileges to use those machines. There is even a morcellation procedure that encases the tissue but it is much less often done.

Patients are typically not told that the surgeon intends to do morcellation during their procedure nor what it means. A patient commented that it was not on their Informed Consent list. Patients need to know. If the doctors aren’t changing their methods to keep up with the new information, the patients need to stand up for themselves and ask and then tell them no.

And to think two or three years ago I was in an OB/GYN’s office debating whether to have fibroid surgery. We decided to see if a little more aging would take care of it, and it did. I had no desire to have my abdomen opened up yet again even a little bit and the gynecologist wasn’t pushing it.

I had no idea….

I’m trying to help get the word out to make sure that others do.


11 Comments so far
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This makes me more glad than ever that my gynecologist had to do a “traditional” hysterectomy when she found that my fibroids were too big to be removed laparoscopically. So I have a scar. At my age, I really don’t care! Thanks for posting this. I would have had no idea otherwise.

Comment by Pegi 03.23.14 @ 5:58 am

Thank you for sharing this!

A friend of mine is going for a similar surgery, but the uterine tube will be removed. It’ll be a more extensive procedure. Still, I’m glad to have the information.

Comment by Suzanne from Montreal 03.23.14 @ 6:25 am

Thank you for posting this. I had a traditional myomectomy 25 years ago, and thankfully, with no horrible adverse effects. This article was terrifying and heart breaking.

Comment by Dee 03.23.14 @ 7:39 am

Chilling. I’m off to find out how morcellation is different from embolization… which did me FAR more harm than good.

Comment by Channon 03.23.14 @ 7:48 am

Scary! It’s like big boys with big toys. They have to try out all the new gadgets, before they are proven to be safe. They consider the losses collateral damage to add to statistics. I think it would be a mighty different story if these surgeons were at the other end of the knife!

Comment by Jody 03.23.14 @ 8:37 am

Thank you!

Comment by Jayleen Hatmaker 03.23.14 @ 11:43 am

I saw that story, and am at the same age my mother had a hysterecotomy for similar problems. I can understand why women would have thought that procedure was a great solution, but am so glad I’m aware of such unintended and potentially horrific consequences. I think word of the danger will spread quickly and I can’t imagine the procedure won’t be banned or modified.

Comment by LynnM 03.23.14 @ 11:49 am

It’s a great article for stimulating questions and discussions. What it doesn’t state clearly is how the rates of cancer compare to women who didn’t go through this process, or how many women suffered life changing (possibly ending) complications from more invasive surgery. It’s really important to look at the whole picture and figure out what is right for each patient. Thank you for reminding us all that we need to educate ourselves!

Comment by twinsetellen 03.23.14 @ 4:56 pm

Thanks for the info…will check it out.

Comment by Ruth 03.23.14 @ 8:37 pm

Thank you for sharing this. I had no idea. Excellent information.

Comment by debbier 03.26.14 @ 9:09 am

You comments and analysis are very much appreciated. Thank you.
My very best,
Hooman Noorchashm MD, PhD
Boston, MA.

Comment by Hooman Noorchashm 03.30.14 @ 6:24 am



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