open access
A self-developed contained bag for laparoscopic myomectomy morcellation
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Soochow University, Suzhou, China, China
- Department of Anesthesiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of Ultrasonography, The Second Affiliated Hospital of Soochow University, Suzhou, China
open access
Abstract
Objectives: Open power morcellation during a laparoscopic myomectomy (LM) can result in the dissemination of benign or occult malignant tumor cells in the abdominopelvic cavity. The development of a new contained collection bag for power morcellation is now favored by gynecologic surgeons worldwide.
Material and methods: This study was a single-arm trial comprising 20 women who consecutively underwent an LM
involving the use of a newly designed contained collection bag for power morcellation between November 3rd 2017 and April 31st 2018. There was also a historical control group consisting of 30 women who underwent open power morcellation during an LM between May 1st 2017 and October 31st 2017. All the essential information concerning the patients and surgically related data, including the myoma size, the operation duration, and the cell count of the intraperitoneal irrigating fluid, were collected and analyzed.
Results: The uterus size and the maximum diameters of the uterus and the myoma of the two groups were not significantly different (p = 0.65, p = 0.71, and p = 0.31, respectively). Pseudopneumoperitoneum was established and clear visualization was guaranteed in all 20 cases in the experimental group. The remaining fragment tissue amount (mean ± SD) and weight (mean ± SD) in the collection bag after morcellation in the experimental group were 5.00 ± 1.48 and 3.87 ± 1.31 (g). All the collection bags were routinely examined after the LM using normal saline, and no leaks or lesions were found. The cell counts of the intraperitoneal irrigating fluid both before and after morcellation were less than 105–106/L. The pathology of all the tissues confirmed that there were no malignant tumors. The operation of the experimental group was 18 mins longer than that of the historical control group (p = 0.00).
Conclusions: This newly designed collection bag system for LM morcellation is effective, feasible, and safe.
Abstract
Objectives: Open power morcellation during a laparoscopic myomectomy (LM) can result in the dissemination of benign or occult malignant tumor cells in the abdominopelvic cavity. The development of a new contained collection bag for power morcellation is now favored by gynecologic surgeons worldwide.
Material and methods: This study was a single-arm trial comprising 20 women who consecutively underwent an LM
involving the use of a newly designed contained collection bag for power morcellation between November 3rd 2017 and April 31st 2018. There was also a historical control group consisting of 30 women who underwent open power morcellation during an LM between May 1st 2017 and October 31st 2017. All the essential information concerning the patients and surgically related data, including the myoma size, the operation duration, and the cell count of the intraperitoneal irrigating fluid, were collected and analyzed.
Results: The uterus size and the maximum diameters of the uterus and the myoma of the two groups were not significantly different (p = 0.65, p = 0.71, and p = 0.31, respectively). Pseudopneumoperitoneum was established and clear visualization was guaranteed in all 20 cases in the experimental group. The remaining fragment tissue amount (mean ± SD) and weight (mean ± SD) in the collection bag after morcellation in the experimental group were 5.00 ± 1.48 and 3.87 ± 1.31 (g). All the collection bags were routinely examined after the LM using normal saline, and no leaks or lesions were found. The cell counts of the intraperitoneal irrigating fluid both before and after morcellation were less than 105–106/L. The pathology of all the tissues confirmed that there were no malignant tumors. The operation of the experimental group was 18 mins longer than that of the historical control group (p = 0.00).
Conclusions: This newly designed collection bag system for LM morcellation is effective, feasible, and safe.
Keywords
contained morcellation; laparoscopic myomectomy; parasitic myoma; uterine sarcoma
Title
A self-developed contained bag for laparoscopic myomectomy morcellation
Journal
Issue
Article type
Research paper
Pages
605-613
Published online
2022-03-03
Page views
4218
Article views/downloads
605
DOI
Pubmed
Bibliographic record
Ginekol Pol 2022;93(8):605-613.
Keywords
contained morcellation
laparoscopic myomectomy
parasitic myoma
uterine sarcoma
Authors
Ying Wei
Xuelan Zhou
Qiong-Zhen Ren
Qi Ma
Xiaomin Tao
Minfang Shao
Suhong Jia
- Tan-Kim J, Hartzell KA, Reinsch CS, et al. Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol. 2015; 212(5): 594.e1–594.10.
- Istre O. Unexpected Uterine Leiomyosarcoma During Laparoscopic Hysterectomy Treated 6 Months With Ulipristal Acetate and Contained Power Morcellation. J Minim Invasive Gynecol. 2017; 24(2): 198.
- Park JY, Kim DY, Kim JH, et al. The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus. Ann Surg Oncol. 2011; 18(12): 3453–3461.
- Ludwin A, Gawron I, Pityński K. Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas. Ginekol Pol. 2018; 89(10): 546–552.
- Food U S. Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication. Center for Devices & Radiological Health, 2014. https://xueshu.baidu.com/usercenter/paper/show?paperid=3eddca96ea9b38c1b8f9bc741523dc3c (15.12.2021).
- Lum DA, Sokol ER, Berek JS, et al. Impact of the 2014 Food and Drug Administration Warnings Against Power Morcellation. J Minim Invasive Gynecol. 2016; 23(4): 548–556.
- Singh SS, Scott S, Bougie O, et al. Technical Update on Tissue Morcellation During Gynaecologic Surgery: Its Uses, Complications, and Risks of Unsuspected Malignancy. Journal of Obstetrics and Gynaecology Canada. 2015; 37(1): 68–78.
- Kanade TT, McKenna JB, Choi S, et al. Sydney contained in bag morcellation for laparoscopic myomectomy. J Minim Invasive Gynecol. 2014; 21(6): 981.
- Park JY, Park SK, Kim DY, et al. The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol. 2011; 122(2): 255–259.
- Oduyebo T, Rauh-Hain AJ, Meserve EE, et al. The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol. 2014; 132(2): 360–365.
- Brölmann H, Tanos V, Grimbizis G, et al. European Society of Gynaecological Endoscopy (ESGE) steering committee on fibroid morcellation. Options on fibroid morcellation: a literature review. Gynecol Surg. 2015; 12(1): 3–15.
- Beckmann MW, Juhasz-Böss I, Denschlag D, et al. Surgical Methods for the Treatment of Uterine Fibroids - Risk of Uterine Sarcoma and Problems of Morcellation: Position Paper of the DGGG. Geburtshilfe Frauenheilkd. 2015; 75(2): 148–164.
- Landman J, Venkatesh R, Kibel A, et al. Modified renal morcellation for renal cell carcinoma: laboratory experience and early clinical application. Urology. 2003; 62(4): 632–4; discussion 635.
- Lambat Emery S, Pluchino N, Petignat P, et al. Cell spillage after contained electromechanical morcellation using a specially designed in-bag system for laparoscopic myomectomy: prospective cohort pilot study. J Minim Invasive Gynecol. 2019; 26(7): 1351–1356.
- Cheung VYT, Pun TC. Contained morcellation for laparoscopic myomectomy within a specially designed bag. J Minim Invasive Gynecol. 2016; 23(1): 139–140.
- Contained Tissue Extraction System. http://medical.olympusamerica.com/products/pneumoliner (15.12.2021).
- Szymczak P, Sawicki S, Wydra D. Laparoscopic supracervical hysterectomy with the use of the More-Cell-Safe system in a patient with uterine leiomyomas. Ginekol Pol. 2017; 88(2): 113–114.
- Rechberger T, Miotła P, Futyma K, et al. Power morcellation for women undergoing laparoscopic supracervical hysterectomy - safety of procedure and clinical experience from 426 cases. Ginekol Pol. 2016; 87(8): 546–551.
- Milad MP, Milad EA. Laparoscopic morcellator-related complications. J Minim Invasive Gynecol. 2014; 21(3): 486–491.
- Vargas MV, Cohen SL, Fuchs-Weizman N, et al. Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol. 2015; 22(3): 433–438.