1.1 Current evidence on the efficacy of hysteroscopic morcellation of uterine leiomyomas (fibroids) is limited in quality and quantity. Evidence on safety shows potential for serious complications. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to do hysteroscopic morcellation of uterine leiomyomas (fibroids) should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information. In particular they should explain the options for treatment and the reasons for considering hysteroscopic morcellation. In addition, the use of NICE's information for the public is recommended.
Audit and review clinical outcomes of all patients having hysteroscopic morcellation of uterine leiomyomas (see section 7.2).
1.3 Hysteroscopic morcellation of uterine leiomyomas (fibroids) should only be done by clinicians with specific training in this technique.
1.4 NICE encourages further research into hysteroscopic morcellation of uterine leiomyomas (fibroids) which could include data collection with publication of the findings, particularly of safety outcomes. Patient selection should be clearly described. Outcomes should include symptom relief, quality of life, recurrence rates and information about fertility and subsequent pregnancies. All complications should be documented. NICE may update the guidance on publication of further evidence.