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387 Morcellation of the uterus in german health care facilities: a comprehensive analysis of surgical data over 17 years
  1. Lina Judit Schiestl,
  2. Annette Hasenburg and
  3. Roxana Schwab
  1. Universitätsmedizin Mainz, Mainz, Germany


Introduction/Background Leiomyomas stand as the predominant benign indication necessitating myomectomy or hysterectomy. However, current imaging procedures face challenges in distinguishing between malignant and benign findings, particularly sarcomas or uterine fibroids. In cases of unsuspected malignancy, intraabdominal morcellation may result in extensive dispersion of malignant cells, leading to a notably poor prognosis. In response to these concerns, the Food and Drug Administration (FDA) raised multiple safety issues regarding the utilization of morcellators in gynecologic procedures in 2014.

Methodology Our study systematically analyzed data from the OPS coding system, presenting the frequency of diverse approaches to myomectomy and hysterectomy in Germany. We elucidated evolving surgical trends over a 17-year period (2005–2021) and scrutinized frequency distributions within distinct age groups. Additionally, we conducted a detailed analysis of surgical approaches to sole myomectomy for the period spanning 2015 to 2021.

Results While vaginal hysterectomy remains the prevailing technique for uterine removal, there has been a substantial 8.6-fold increase in laparoscopically performed hysterectomies from 2005 to 2021. Laparoscopic procedures have become the predominant approach for myomectomies in pre- and perimenopausal women. Notably, we observed no significant reduction in uterine morcellation in Germany between 2014 (n=15,988) and 2021 (n=15,328).

Conclusion The observed increase in laparoscopic procedures over the 17-year period may be attributed to enhanced skills in laparoscopic techniques and potentially driven by higher reimbursement for these procedures. Despite declining trends in this procedure seen in other countries, such as the US, there was no decrease in intraabdominal morcellation between 2014 and 2021. However, the data do not provide information on whether morcellation was performed within a safety bag. As discussions regarding the safety of morcellation persist, further research and vigilance are imperative to mitigate potential adverse outcomes in cases of preoperative occult malignant conditions.

Disclosures None.

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