Can In-Bag Manual Morcellation Represent an Alternative to Uncontained Power Morcellation in Laparoscopic Myomectomy? A Randomized Controlled Trial

Abstract

Aims: The study aimed to evaluate feasibility and safety of in-bag manual morcellation compared to uncontained power morcellation during laparoscopic myomectomy. Methods: A total of 72 women undergoing laparoscopic myomectomy were randomized into 2 treatment groups: 34 patients underwent in-bag manual morcellation (experimental group) and 38 were submitted to uncontained power morcellation (control group). The primary end point was the comparison of morcellation operative time (MOT). Total operative time (TOT), rate of intraoperative complication, and postoperative outcomes in the 2 groups were regarded as secondary outcomes. Results: Mean MOT and TOT were longer in the experimental group than in the control one (MOT: 9.47 ± 5.05 vs. 6.16 ± 7.73 min; p = 0.01; TOT: 113.24 ± 28.12 vs. 96.74 ± 33.51 min; p = 0.01). No intraoperative complications occurred in either group and no cases of bag disruption or laparotomic conversion were recorded. No significant difference in hemoglobin drop, hospital stay, and postoperative outcomes was reported between groups. Conclusion: In-bag manual morcellation appears a safe and feasible procedure and, despite slightly longer operative time, could represent an alternative to uncontained power morcellation.

Disseminated peritoneal leiomyomatosis: a devastating sequelae of unconfined laparoscopic morcellation

“…(13) Contained power morcellation In a bid to circumvent the problem of peritoneal dissemination while preserving the perioperative benefits of an MIS approach in the management of uterine leiomyomas, several authors have published their experience with contained ('in-bag') morcellation techniques. (14) Studies comparing the conventional unconfined version with this newer contained technique of power morcellation mostly report similar intraoperative blood loss, postoperative complication rates and length of stay, with the downside of a slightly longer average operative duration of 17-26 minutes when compared with the contained technique. (14) The slightly longer operative duration may in part be related to a surmountable initial lack of familiarity with the contained technique and may be worthwhile to minimise the risk of the sequelae of DPL down the line.…”

“…(14) Studies comparing the conventional unconfined version with this newer contained technique of power morcellation mostly report similar intraoperative blood loss, postoperative complication rates and length of stay, with the downside of a slightly longer average operative duration of 17-26 minutes when compared with the contained technique. (14) The slightly longer operative duration may in part be related to a surmountable initial lack of familiarity with the contained technique and may be worthwhile to minimise the risk of the sequelae of DPL down the line.…”

First Impressions Can Be Deceiving: Surgical Outcomes of Laparoscopic Myomectomy in Patients Pretreated with Ulipristal Acetate

“…In all patients, surgery was performed in the follicular phase of the menstrual cycle, according to a previously described technique [19]. Myomas were manually morcellated inside an endobag, with edges pulled and removed through the lower central 10-mm trocar incision, previously enlarged to 20 mm [20].…”

New Surgical Technique for Robotic Myomectomy: Continuous Locking Suture on Myoma (LSOM) Technique

“…Minimally invasive myomectomy for multiple myomas often requires extra time for identifying the retrieved myomas in the abdominal cavity. Surgeons usually remove the retrieved myomas at the end stage of the minimally invasive myomectomy by intracorporeal or extracorporeal morcellation via an intra-abdominal uncontained power morcellation or a protected in-bag extracorporeal manual morcellation [17,18], instead of removing the retrieved myomas piece-by-piece whenever the myomas were removed from the uterus, as in abdominal myomectomies. However, this surgical procedure can sometimes be challenging, as the retrieved myomas can become lost in the abdominal cavity and embed within the bowel loop.…”