“Contain before transection, contain before manual morcellation” with a tissue pouch in laparoendoscopic single-site subtotal hysterectomy

Wu, Meng‐Yu; Ding, Dah-Ching; Chu, Tang–Yuan; Hong, Mun-Kun

doi:10.1016/j.gmit.2016.02.005

Cited by 10 publications

(15 citation statements)

References 10 publications

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“…13 Now, with the availability of bags with separate sleeve puncture of the bag that can be ligated before the bag is removed from the abdominal cavity, the procedure seems to be more simple and fairly safe. However, the number of cases and studies are not very high, and some of them are in animal models.…”

Section: Discussionmentioning

confidence: 99%

Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases

Torrent-ColomerAnna

ClaretAlbert

Vicens-VidalMargalida

et al. 2019

Journal of Gynecologic Surgery

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Objective: One aim of this article is to present 2 cases of parasitic myomas and 2 cases of leiomyomatosis peritonealis disseminata (LPD) after laparoscopic surgery with electrical morcellation. Other aims include reporting the current authors' incidence and reviewing the literature briefly. Cases: In these 4 cases, an electric tissue morcellator was used for myoma removal without any containment technique. All cases were symptomatic and 1 of them also presented with a 3-cm endometrioma nodule in the port site where the morcellator had been introduced in a previous surgery. All of the patients were young (< 40 years). No case of an unsuspected uterine sarcoma was seen. Results: The final histopathology was benign in all cases. Currently, all patients are asymptomatic. Conclusions: Laparoscopic morcellation of myomas without containment techniques is associated with an increased risk of parasitic myomas or LPD, mainly in reproductive-age women. Techniques for contained morcellation of the uterine tissue should be performed in an attempt to prevent this complication. ( J GYNECOL SURG 2017:1)

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Section: Discussionmentioning

confidence: 99%

Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases

Torrent-ColomerAnna

ClaretAlbert

Vicens-VidalMargalida

et al. 2019

Journal of Gynecologic Surgery

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“…Specimen removal with contained manual morcellation [ 20 ] in this study enabled more efficient control over the dissemination of parasitic myomas, endometrioid glands, or occult cancerous cells [ 22 23 24 ]. Benign sequelae of morcellation actually occurred more often than malignant dissemination of sarcomatous tissue [ 25 26 27 ].…”

Section: Discussionmentioning

confidence: 99%

“…In brief, in Phase 1, the LESS approach [ Figure 1c ] [ 19 ] involving supracervical hysterectomy [ Figure 1a ] with a cutting loop (KARL STORZ, Germany) was performed, followed by cervical internal orifice conization [Figure 1a and d ] using a cutting loop (26183 MB, KARL STORZ, Germany). The uterine specimens were contained in a tissue pouch (Cook Medical Inc., Bloomington, IN, USA), and the pouch was opened at the umbilical port wound where the uterine body was cut into long strips [ Figure 1e ] [ 20 ]; in Phase 2, a wide excision of the cervix [Figure 1f and g ], including the cervical canal [ Figure 1i ] and transformation zone [ Figure 1j ], was performed. Then, the remaining part of the cervix was sutured interruptedly with 1-0 Monocryl [ Figure 1h ].…”

Section: Aterials and Methodsmentioning

confidence: 99%

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Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: An initial experience

Hong¹,

Chu²,

Wang³

et al. 2017

Tzu Chi Med J

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Objective:To report our initial experience with and the short-term outcomes of two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy (LESS-CLSH).Materials and Methods:A retrospective case study included 40 women who underwent LESS-CLSH from January 2014 to December 2016 at Buddhist Tzu Chi General Hospital. Uterine specimens were extracted through contained manual morcellation with a tissue pouch. The first phase was LESS supracervical hysterectomy and conization of the internal orifice of the cervix. The second phase was transvaginal cervical conization and cylinderization. Women with a uterus diameter of >12 cm, a broad ligament myoma, or severe pelvic adhesion were categorized into a difficult group, and others were categorized into a nondifficult group.Results:The difficult group required more time and had more blood loss than the nondifficult group. The mean surgical time was 187.2 ± 33.9 and 139.1 ± 20.7 min, and the mean blood loss was 533.3 ± 333.3 and 225.3 ± 168.2 mL in the difficult and nondifficult groups, respectively. The overall visual analog scale (VAS) pain scores at 0–4, 24, and 48 h after surgery were 7.1 ± 1.9, 4.2 ± 1.6, and 2.3 ± 1.5, respectively; no difference in the VAS pain scores, pain relief score, and hospitalization duration was observed between the two groups. Minor surgical complications or adverse events on follow-up were noted. Three months after surgery, the diameter and thickness of the cervix were decreased by approximately 0.5 and 1.0 cm, respectively.Conclusion:LESS-CLSH is a minimally invasive, safe, and feasible approach, even for difficult laparoscopic hysterectomy. Contained manual morcellation enables more controlled specimen removal than morcellation only.

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“…The pioneers of microinvasive surgery can establish a novel approach on silent mentors prior to applying it to patients. For example, in 2014, we first created the novel two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy, 8 specimen removal concept by containing prior to transection and morcellation, 9 or advanced laparoendoscopic single-site surgical techniques 10 on silent mentors; this approach can markedly contribute to the development of minimally invasive surgery. Our minimally invasive surgery team intended to introduce single-port laparoscopic sacrocolpopexy to patients last year; however, the first surgical experience with silent mentors revealed that it was not the appropriate time because of many technical problems requiring resolution.…”

Section: Silent Mentor Program Improves Our Surgical Level and Patienmentioning

confidence: 99%

How the silent mentor program improves our surgical level and safety and nourishes our spiritual life

Hong

Chu

Ding

2017

Gynecology and Minimally Invasive Therapy

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We briefly share our experience of using the silent mentor program in the Medical Simulation Center (MSC) of Tzu Chi University (TCU), Hualien, Taiwan, to improve our minimally invasive surgical level and patient’s safety. The silent mentor program, established in 2000 by the Department of Anatomy of TCU, is a pioneering clinical skill training program based on unembalmed bodies. This program provides three valuable advantages for surgery. The first is the comprehensive understanding of the deep or rarely observed but crucial structures of the human body, which is normally difficult to achieve in living humans. The second is gaining the first experience of a novel procedure or surgery on silent mentors rather than on living humans, which is essential for young surgeons to begin their careers. The third is evaluating the safety and feasibility of a novel surgical method. In addition to surgical techniques, the most valuable point of the program is the humane ceremonies conducted for silent mentors to nourish our soul. After the workshop, all the incision wounds on every silent mentor were carefully checked and sutured in the same manner as in closing surgical wounds in a patient. Subsequently, encoffining, cremation, and thanksgiving ceremonies were solemnly held, in the hope that the medical students or trainees would imperceptibly understand their responsibility to society and the silent mentor’s expectations. The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy, or the Taiwan Association for Minimally Gynecology Therapy, or both can consider initiating a regular silent mentor program in the MSC of TCU. It is not only intended to improve the skills of surgeons but also to allow them to participate in the interactive ceremony and thus refresh their humanitarian knowledge.

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“Contain before transection, contain before manual morcellation” with a tissue pouch in laparoendoscopic single-site subtotal hysterectomy

Cited by 10 publications

References 10 publications

Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases

Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases

Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: An initial experience

How the silent mentor program improves our surgical level and safety and nourishes our spiritual life

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