Study Objective To evaluate contained bag electromechanical morcellation for removal of myomas and uterus with myomas, laparoscopically (Study group B), and compare it with uncontained laparoscopic morcellation (Control group A) in patients with similar parameters done earlier. Design Retrospective Cohort Comparative Study (Canadian Task Force 2-1).Setting Advanced Gynaecologic MAS, university recognized tertiary centre, Mumbai, India. Patients 720 women had laparoscopic removal of myomas or large uterus with myomas during a study period of 6 years (from 13 May 2012 to 14 August 2018) with contained bag electromechanical or conventional morcellation. Interventions Laparoscopic hysterectomy, laparoscopic myomectomy, conventional uncontained morcellation, contained in-bag morcellation. Main Outcomes Measures Laparoscopic contained in-bag morcellation was compared with conventional morcellation of myomas and uterus with large myomas during a study period of 6 years. Parameters assessed were operating time, time for insertion of bag, morcellation of tissues and removal of bag, blood loss, complications, conversion to open surgery and histopathologic findings of tissues. In Group A, in the first 3 years, 355 women underwent uncontained morcellation. Myoma size and weight varied from 5 cm to 26 cm and 200 g to 3740 g respectively. The myoma number ranged from 1 to 18. No case of leiomyosarcoma was reported. In Group B, in the next 3 years, 365 women underwent contained bag morcellation in 196 myomectomy cases and 169 hysterectomy cases. Myoma size and weight varied from 4 cm to 20 cm and 200 g to 2100 g respectively. The number of myomas varied from 1 to 17. Results and ConclusionLaparoscopic contained bag morcellation for myomas and uterus with large myomas were evaluated. In myomectomy group both conventional and in bag laparoscopic morcellation were comparable in terms of duration of the surgery and blood loss. When all cases ( hysterectomy and myomectomy combined together) and cases of hysterectomy with large fibroid were studied, laparoscopic in bag morcellation took less operative time and there was statistically significant difference in operative time . No case of leiomyosarcoma was found in our study of 720 cases of myomas or uterus with large myomas.
Further studies should be directed toward identifying patients at high risk of ULMS prior to presumed leiomyoma resection in order to reduce the risk of inadvertent tumor morcellation.
Background: SARS-CoV-2 virus is largely transmitted via respiratory droplets and the highest transmission risks arise when undertaking aerosol generating procedures like laparoscopy. Most national societies had advised the urgent suspension of elective surgery with the focus shifting to emergency and cancer surgery only during this pandemic. However very little is known regarding the risks to the health care professionals undertaking emergency laparoscopic procedures. Aims and Objective: To demonstrate safety at laparoscopy by modifying the technique for safe management of patients during the COVID-19 pandemic. Design and Setting: This is an observational cohort study. This study was done at a tertiary care reference hospital for minimal access gynaecological surgery. Safety of 42 semi-urgent and emergency laparoscopic surgeries in patients was evaluated for a period of 5 months after taking informed written consent of patients to participate in the study. Materials and Methods: Use of double closed circuit laparoscopic suction evacuation and filtration systems with closed circuit anaesthesia with specialized Heat and Moisture Exchangers (HME) bacterial & viral (BV) filters to make laparoscopic surgery safe. Results: 57.14% of the patients were 41 years or more. 47.6% presented either with menorrhagia, irregular vaginal bleeding or post-menopausal vaginal bleeding and 26.19 % patients were keen to conceive. In 50% patients, surgery was done in 60 minutes or less. Post-operatively, none of the patients had any complications and all were followed up for 14 days for COVID-19 infection. No staff, doctors or anaesthetist were detected COVID-19 positive during the follow up period. The limitation of the study was, that it was an observational study done in COVID-19 negative patients only. Conclusions: Safety at laparoscopy can be maintained when it is performed by an experienced surgeon who has full knowledge of safe laparoscopic techniques and performs it in the shortest time possible and with all due precautions.
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