Laparoscopic removal of uterine fibroids with power morcellation

Evidence-based recommendations on laparoscopic removal of uterine fibroids with power morcellation in adults. This involves cutting the fibroids into small pieces to remove them.

# Recommendations
Evidence on the safety of laparoscopic removal of uterine fibroids with power morcellation shows potentially serious complications. In particular there is a risk of spreading undiagnosed malignant tissue, which has higher prevalence in people who are postmenopausal or over 50. Evidence on the procedure's efficacy is limited in quantity. Therefore:
For people who are postmenopausal or over 50, this procedure should not be used. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.
For people who are premenopausal or 50 or under, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
Further research should report details of patient selection, surgical technique (including any containment system used) and long-term outcomes.
Clinicians wishing to do laparoscopic removal of uterine fibroids with power morcellation in people who are premenopausal or 50 or under should:
Inform the clinical governance leads in their healthcare organisation.
Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. Also see the Royal College of Obstetricians and Gynaecologists' advice on obtaining consent from women having this procedure.
Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. Also see the Royal College of Obstetricians and Gynaecologists' information for patients who may be considering this procedure.
Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
Healthcare organisations should:
Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.
Regularly review data on outcomes and safety for this procedure.
This procedure should only be done by a surgeon with specific training in laparoscopic surgery. When an in-bag technique is needed, the surgeon should also have specific training in using containment systems.# The condition, current treatments and procedure

# The condition
Uterine fibroids (also known as uterine leiomyomas or myomas) are benign tumours of the uterus. They can be asymptomatic or can cause symptoms including heavy periods or intermenstrual bleeding. They can be associated with fertility problems and miscarriage.

# Current treatments
Treatment depends on whether the fibroids cause symptoms, and if the person would like to become pregnant in the future. For symptomatic fibroids, treatment options include medication, interventional radiology and surgery. Interventional radiology treatments include uterine artery embolisation and MRIguided focused ultrasound. Surgery includes hysterectomy, myomectomy, endometrial ablation techniques and myolysis.

# The procedure
Laparoscopic surgery with power morcellation allows uterine fibroids to be cut into smaller pieces so they can be removed laparoscopically and without the need for a laparotomy. The procedure aims to reduce symptoms caused by fibroids.
Laparoscopic removal of uterine fibroids with power morcellation is done with the patient under general anaesthesia. During laparoscopic surgery and under direct visualisation an electrosurgical morcellator is introduced through a small incision into the abdomen and used to cut the uterine fibroid into smaller pieces. If a hysterectomy is planned, morcellation can be used to also remove part or all of the uterus. The fragments are removed through the morcellation cannula. The removed tissue should be sent for histological analysis. To reduce the risk of disseminating benign and malignant uterine tissue, the tissue can be contained in an insufflated sterile bag while being morcellated within the abdomen.