Morcellation of apparent benign uterine myoma: assessing risk to benefit ratio

Specimen extraction is one of the most challenging steps during minimally invasive procedures. Theoretically, any surgical specimens have to be considered potentially malignant and therefore they have to be removed without contamination of the operative field [1]. However, solid and large masses (e.g., uterine myomas) cannot be removed easily, from the small abdominal incisions used for minimally invasive operations. Power morcellators, thanks to the fragmentation of these masses, allow their extraction from small laparoscopic incisions. Notwithstanding, the tissue morcellation may spread potential malignant surgical debris into the abdominal cavity, thus upstaging organ-confined malignancies to intraabdominal disease. Although the incidence of undiagnosed uterine malignancies is low, accumulating evidence supports that morcellation impacts on cancer patients’ prognosis [2].