The women's health-care community got a shock to the system in December, when leading U.S. hospitals abruptly began acknowledging that a commonly used surgical tool risked killing some women.
The tool, used since the 1990s in many hysterectomies, can stir up aggressive cancers, they said. Brigham and Women's Hospital, Temple University Hospital and others quickly altered their procedures for the tool's use. The Food and Drug Administration has begun a probe of its risks.
Yet there were hints of the tool's potentially fatal flaw going back to its early years. Doctors use the device, called a power morcellator, through tiny incisions to cut into, or "morcellate," the uterus and remove it. The procedure is popular because it allows speedier recovery than open surgery and is easier to perform than many alternatives.
Doctors who trained others on some early morcellators, including one named "Diva," noticed in the late 1990s that they sometimes left behind tissue fragments. Data as early as 2003 suggested that, if those bits were malignant, they could seed rapid cancer growth. Although some morcellator makers have long recommended containing risky tissue in a surgical bag—standard practice in many specialties—gynecologists rarely used bags, considering the risk too low and their use too cumbersome.
"I don't think there is an acceptable safe morcellator" without systems to contain tissue, said Bobbie Gostout, Mayo Clinic's chairwoman of obstetrics and gynecology, at a 2011 conference where a study highlighted the device's cancer-spreading risk. That risk, she said, "seems just out of bounds."