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5 7 J U N E 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E cence and vaginal cuff hemorrhage. Though the advisory is bound to have a chilling effect, I think eliminating morcellators is shortsighted. Our goal is to help patients, not make medico- legal decisions in response to an overbroad FDA advisory. After all, most insti- tutions haven't removed mesh as an option for total vaginal vault prolapse, despite "black box" warnings. Officially, we've been "discouraged" by the FDA from using "laparoscopic power morcellation during hysterectomy or myomectomy for the treatment of women with uterine fibroids." The FDA also says we should thoroughly discuss the benefits and risks of all treatments with patients, and that individ- ual patients for whom careful benefit-risk evaluation shows that laparoscopic power morcellation is considered the best therapeutic option need to be informed that their fibroid(s) may contain cancerous tissue and that morcel- lation can spread the cancer. Have we always had that conversation? Perhaps not, because the general perception has been that it's extremely rare, and that the nature of the dis- ease made the method of removal largely irrelevant due to the dismal prog- nosis. But given the increased concern that morcellation of a fibroid con- taining an undiagnosed uterine sarcoma could adversely alter the prognosis for even one patient, all patients should be warned of this possibility and offered alternative approaches, even if the alternatives are potentially more morbid and not minimally invasive. Do no harm The American Association of Gynecologic Laparoscopists (AAGL) has responded to the advisory, acknowledging that it's "of paramount impor- tance that our patients are counseled appropriately about the dissemina- tion risks associated with intracorporeal morcellation." But the AAGL also stresses the importance of having patients and the public "recognize the benefits provided to the vast majority undergoing minimally invasive sur- G Y N E C O L O G Y OSE_1406_part2_Layout 1 6/13/14 11:40 AM Page 57