In that case, the F.D.A. did step in and recommend that the devices not be used “in the vast majority of women” undergoing fibroid surgery. Their use fell off sharply.
Morcellation is not used in surgery for cervical cancer. When minimally invasive surgery is performed, the uterus is removed intact through the vagina.
The study included 631 women and 33 hospitals in the United States, Colombia, Brazil, Peru, Italy, China, Australia and Mexico.
The results affect a relatively small number of women in the United States, where screening has reduced the incidence of cervical cancer to about 13,000 cases a year, with about 4,000 deaths. But worldwide, cervical cancer is the fourth most common malignancy and cause of cancer death in women, with 570,000 cases a year and 270,000 deaths.
The disease is caused in nearly all cases by the human papillomavirus, HPV, an extremely common, sexually transmitted virus. In most people, the immune system clears the virus and they never knew they were infected. But in some it persists, and can cause cervical cancer and other malignancies.
Dr. Ramirez said women with cervical cancer should discuss the types of surgery with their doctors, and should “question the approach of having minimally invasive surgery if that is what is suggested to them.”
Dr. Amanda N. Fader, director of the Kelly Gynecologic-Oncology Service at Johns Hopkins University, and the author of an editorial that accompanies the studies, said the results had “dealt a great blow” to the minimally invasive surgical method for cervical cancer. Johns Hopkins has also halted the procedure, reverting to open surgery “for the time being,” she said.