Myometrial smooth muscle cells spillage during open myomectomy: Is it True or a myth?

Background: Uncontained morcellation of myoma during laparoscopic surgery has been discouraged because of unknown malignancy. Even the safety of contained morcellation has been questioned because muscle cells have been detected in washings obtained during laparoscopic procedures. The possibility of myoma cell dissemination has been observed in open abdominal surgery, even after hysterectomy. Thus myomectomy would be unsafe from an oncological point of view, regardless of surgical approach. Methods: This is an observational cohort study involving 30 patients who underwent open abdominal myomectomy. Peritoneal abdominal washings were obtained two times during the open abdominal myomectomy: before uterus incision and after the myomectomy itself. Cytological, cell block, and immunohistochemical evaluations were performed. Results: All washings obtained immediately after abdominal peritoneal cavity opening were negative for fibroid cells. Both the first and second washings were free of myoma cells. Cytologic evaluation did not reveal any smooth muscle cells. The results of desmin and smooth muscle actin staining, performed on the pre- and post-myomectomy samples, were negative. Conclusion: Our results demonstrated, for the first time to our knowledge, that there is no dissemination of myoma cells during conservative abdominal surgery. It could represent an additional oncological safety. Further data are needed.