Yusuf Aytaç TOHMA, Eda KOCAMAN, Mehmet TUNÇ, Hüseyin AKILLI, Hulusi Bülent ZEYNELOĞLU, Ali AYHAN

MİNİMAL İNVAZİV CERRAHİDE UTERİN MORSELASYON, UYGULANMALI MI ? UYGULANMAMALI MI ?

Son yıllarda jinekolojide minimal invaziv cerrahi, açık abdominal cerrahilere tercih edilmektedir. Minimal invaziv cerrahideki en büyük problemlerden biri büyük uterusların ve leiomyomların batın dışına çıkarılmasıdır. Bu amaçla morselatör olarak adlandırılan ve dokuların elektromekanik güç ile ya da manuel olarak küçük parçalara bölünerek batın dışına çıkarılmasını sağlayan cerrahi aletler kullanılmaktadır. The US Food and Drug Administration (FDA)’nın power morselatör kul-lanımı ile ilgili güvenlik uyarısı sonrasında, minimal invaziv cerrahide büyük uterus ve myomların çıkarılması ile ilgili derlemeler artmıştır. Tanı konulmamış uterin sarkomların morselasyonu neden-li, hastaların kötü sağkalım sonuçlarını gösteren bilimsel kanıtlar artmaktadır. Fakat şu anda okült uterus maligniteleri ile ilgili az sayıda veri bulunmaktadır. Biz bu derlemede, morselasyonun tanı konulmamış uterus malignitelerinin üzerindeki etkisini, uterin sarkomların preoperatif tanısı için kullanılabilecek radyolojik görüntüleme tekniklerini ve potansiyel malign dokuların intraabdomi-nal yayılımının nasıl önüne geçilebileceğini tartıştık fakat şu anki veriler ışığında klinik pratikte intraabdominal morselasyondan kaçınılmalıdır

Anahtar Kelimeler:

Uterin sarkom, power morselasyon, minimal invaziv cerrahi

UTERINE MORCELLATION IN MINIMALLY INVASIVE SURGERY, SHOULD BE APPLIED ? OR SHOULD NOT BE APPLIED ?

In recent years, minimally invasive surgery has been preferred to open abdominal procedures in gynecology. The one of the biggest problem in minimally invasive surgery is extraction of large uteri or myomas. For this purpose, morcellators are used for removal of tissues which are divided into small pieces with electromechanical or manuel power. Since the safety warning from the US Food and Drug Administration about the use of power morcellators, minimally invasive procedures involving the removal of large uterus and myomas are under review. Scientific proofs about that morcellation of undiagnosed uterine sarcomas is associated with worse survival outcomes of pa-tients are increasing. However currently a few data about morcellation of occult uterine malignan-cies are available. We will discuss the effects of morcellation of undiagnosed uterine malignancies, focusing on possible radiologic imaging techniques for preoperative diagnosis of uterine sarcoma and for avoiding intra-abdominal dissemination of potentially malignant tissues in this review. However, according to current data, intra-abdominal morcellation should be banned from clinical practice.

Keywords:

Uterine sarcoma, power morcellation, minimal invasive surgery,

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