Closing the Containment Gap: Protecting Patients in Gynecologic Surgery

Society of Gynecologic Oncology Newsletter

In 2014, the U.S. Food and Drug Administration (FDA) issued a safety communication cautioning against uncontained laparoscopic power morcellation for hysterectomy and myomectomy due to the risk of spreading unsuspected uterine malignancy. Hospitals responded by removing powered devices from operating rooms. But in many cases, this shift simply replaced power with manual morcellation through small abdominal or vaginal incisions — often without containment.

A decade later, the core hazard remains: tissue fragmentation inside the abdominal cavity without an effective containment barrier.

The Evidence Gap

A recent national survey of first-year fellows in minimally invasive gynecologic surgery (FMIGS) highlights troubling patterns:

60% use manual abdominal morcellation in most cases

97% reported never using power morcellation

45% use non–FDA cleared specimen retrieval bags off label

81% of those using the standard FDA-cleared systems do not consistently apply all protective components

35% estimate bag punctures in at least 30% of procedures

These findings underscore an ongoing vulnerability in surgical practice — one that can spread both malignant and benign tissue, including endometriosis and parasitic myomas.

Training the Next Generation

Because this survey reflects the training of current fellows, it suggests that unsafe practices are being passed on to the next generation of surgeons. Unless addressed, these practices risk becoming further entrenched in routine care.

Why This Matters for Gynecologic Oncology

Gynecologic oncologists are uniquely positioned to appreciate the downstream consequences of uncontained morcellation. When an unsuspected sarcoma is disseminated during surgery, it can upstage the disease and significantly reduce survival. Even benign tissue dissemination can result in complex repeat surgeries and reduced quality of life.

A Call to Leadership

The FDA’s 2014 guidance addressed a genuine and preventable risk, but the response did not close the containment gap. Gynecologic oncology can lead the way in ensuring that no patient undergoing morcellation is left unprotected. Professional guidance can also give surgeons the leverage they need to secure FDA-cleared devices from their hospitals, rather than being forced into unsafe improvisation.

By uniting across subspecialties to make containment the standard of care, we can improve outcomes, reduce complications, and honor our shared commitment to patient safety.

Read the full survey article and author information here

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About Ark Surgical

Ark Surgical is a medical device company dedicated to developing safer solutions for gynecologic surgery. Its flagship product, the LapBox® dual-wall tissue containment system, was designed to address the risks identified in this survey by providing surgeons with a robust, FDA-cleared option for contained tissue extraction.