Smooth Muscle Cells in Pelvic Washings At Time of Benign Hysterectomy.

STUDY OBJECTIVE: To evaluate if smooth muscle cells can be detected in pelvic washings at the time of intact hysterectomy.

DESIGN: A multi-centered pilot cohort study (Canadian Task Force Classification of Study Design Class II-2).

SETTING: Two academically affiliated tertiary referral centers.

PATIENTS: Patients undergoing total hysterectomy for benign indications without morcellation by minimally invasive gynecologic surgeons were enrolled from January 2018 to July 2018.

INTERVENTIONS: Pelvic washings were collected at 2 times during surgery: after abdominal entry and after vaginal cuff closure. Cell blocks were generated, slides were stained using hematoxylin and eosin (H&E), smooth muscle actin (SMA) and desmin, and interpreted by one expert pathologist at each institution.

MEASUREMENTS AND MAIN RESULTS: Thirty-eight subjects were recruited; three subjects were excluded due to unplanned morcellation. Smooth muscle uterine cells were detected in 1 pre-wash specimen and 2 post-wash cases. The group with positive washings was noted to have longer procedure time (136 minutes versus 114 minutes), lower blood loss (25 mL versus 86 mL) and higher uterine weight compared to negative washings group (242 grams versus 234 grams).

CONCLUSION: Tissue dissemination of uterine cells may be possible at time of hysterectomy. Larger prospective studies are needed in order to better describe the incidence of and risk factors for tissue dissemination.