Zahra Asgari - Department of obstetrics and gynecology, Arash hospital, Tehran University of Medical Sciences, Tehran, Iran
Maryam Hashemi - Isfahan, hezarjarib st, kooye jadide ostadan, western first golestan alley
Reihaneh Hosseini - Isfahan, hezarjarib st, kooye jadide ostadan, western first golestan alley, Obstetrician & Gynecology/fellowship of laparoscopy
Mahdi Sepidarkish - Tehran university of medical science

Introduction : To remove large myomas in laparoscopy, morcellation is needed. Morcellation, however, has been associated with benign and malignant tissue dissemination. The U.S. Food and Drug Administration (FDA) issued a safety notice in April 2014 discouraging the use of morcellation for uterine tumors due to subsequent upstaging of the disease.. After that , the FDA issued a statement in November 2014 banning the use of morcellation in the menopause and perimenopause, but allowing its use with caution for younger women undergoing myomectomy.The objective of this study was to determine whether morcellation caused dissemination of myometrial cells into peritoneal cavity in comparison with open myomectomy without morcellation, also perioperative outcomes are compared between two procedures.Methods : This study was prospective non- randomised (quasi experimental) trial in Arash hospital of Tehran. The trial participants were women aged under 45 years old undergoing laparoscopic myomectomy or open myomectomy for suspected benign myomas. Washings of peritoneal cavity for detection of spindle cells were performed at 2 times during laparoscopic myomectomy: The first washing was after myometrial incision closure and before morcellation and the second washing was done after morcellation. This procedure was also performed once during open myomectomy. It was after completing myomectomy and incision closure. After peritoneal washing with 200cc normal saline, we collected 30cc of liquid and sent it to laboratory for detection of spindle cells.Results: Between October 15, 2016 and April 30, 2018, 150 patients were assigned to undergo laparoscopic or open myomectomy. 78 subjects in laparoscopic myomectomy and 72 subjects in open myomectomy. A total of 494 myomas were removed: 116(23.48%) by laparoscopy and 378(76.52%) by laparotomy. The number of myomas in the open myomectomy group was significantly higher than the laparoscopic myomectomy group (MD: 3.76, 95 % CI: 2.12 to 5.39, P= 0.001). The mean weight of the enucleated myomas in the open myomectomy group was significantly higher than the laparoscopic myomectomy group (MD: 111.72 g, 95 % CI: 58.03 to 165.41, P= 0.001). After morcellation, the incidence of spindle cell was 2.6% (2/78) in laparoscopic myomectomy and 6.9% (5/72) in open myomectomy group respectively (P= 0.204). Multivariate analysis revealed that the incidence of spindle cell (OR: 3.66, 95%CI: 0.62 to 21.43, P= 0.149) was identical between two groups after controlling the effect of number of myomas and weight of the myomas removed from each patient.Conclusion: Morcellation could not be a factor for tissue dissemination alone and other factors like manipulaton for removing myomas may be reason.

Laparoscopic myomectomy, open myomectomy, morcellation, spindle cell