Laparoscopic removal of uterine fibroids with power morcellation

Evidence on the safety of laparoscopic removal of uterine fibroids with power morcellation shows potentially serious complications. In particular there is a risk of spreading undiagnosed malignant tissue, which has higher prevalence in people who are postmenopausal or over 50. Evidence on the procedure's efficacy is limited in quantity. Therefore:

• For people who are postmenopausal or over 50, this procedure should not be used. Find out why NICE recommends not to use some procedures on the NICE interventional procedures guidance page.

• For people who are premenopausal or 50 or under, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

Further research should report details of patient selection, surgical technique (including any containment system used) and long-term outcomes.

Clinicians wishing to do laparoscopic removal of uterine fibroids with power morcellation in people who are premenopausal or 50 or under should:

• Inform the clinical governance leads in their healthcare organisation.

• Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. Also see the Royal College of Obstetricians and Gynaecologists' advice on obtaining consent from women having this procedure.

• Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. Also see the Royal College of Obstetricians and Gynaecologists' information for patients who may be considering this procedure.

• Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedures outcomes audit tool (for use at local discretion).

• Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

Healthcare organisations should:

• Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure.

• Regularly review data on outcomes and safety for this procedure.

This procedure should only be done by a surgeon with specific training in laparoscopic surgery. When an in-bag technique is needed, the surgeon should also have specific training in using containment systems.