In-Bag Morcellation as a Routine for Laparoscopic Hysterectomy

Abstract

Tissue morcellation during laparoscopic hysterectomy carries the risk of spreading cells from unsuspected malignancy. Contained morcellation inside a bag is supposed to minimize this risk. The present study evaluated routine use of in-bag morcellation during laparoscopic hysterectomy in a consecutive patient cohort (n = 49). The system used was More-Cell-Safe (A.M.I. Austria). Median age was 47 (35 to 76) years and BMI 25.1 (18.8 to 39.8). Indications for hysterectomy were fibroids (71.4%), adenomyosis (16.3%), prolapse (8.2%), and bleeding disorders (4.1%). 48 (98%) patients underwent supracervical hysterectomy and 1 (2%) underwent total hysterectomy. No unsuspected malignancy occurred. Median weight of extirpated tissue was 195 g (18 to 1110). Residual tissue and/or fluid in the bag amounted to 29 g (0 to 291). Median overall duration of surgeries was 100.5 min, and median time associated with the use of the bag was 10 min (5 to 28), significantly correlated with uterine volume (p = 0.0094) and specimen weight (p = 0.0002), but not with patient's BMI (p = 0.6970). Technical success rate for contained morcellation was 93.9%. Peritoneal washings after contained morcellation were all negative for malignant or smooth muscle cells.

Robot‐assisted surgery for the management of apical prolapse: a bi‐centre prospective cohort study

“…Additional procedures were performed when clinically indicated. As a result of recent scientific data on the pathophysiology of ovarian malignancy and spill in the case of sarcoma, concomitant salpingectomy and ‘in bag’ morcellation was performed from the year 2015 onwards …”

Iatrogenic parasitic myoma and iatrogenic adenomyoma after laparoscopic morcellation: A mini-review

“…Morcellation in a bag is proposed for myomas and for the uterus and does not require additional advanced surgical skills. In cases of uterine morcellation (subtotal or total hysterectomy), the use of a bag may systematically include conditions without anatomopathological modifications, such as uterine prolapse [51]. In 2016, the FDA approved the first bag for contained morcellation [52].…”

Comparison of Robotic and Laparoscopic Hysterectomy for the Large Uterus

“…Peritoneal washings after contained morcellation were all negative for malignant or smooth-muscle cells. 16,17 When the 3 methods of morcellation were compared, there was no significant difference between the 3 morcellation techniques in peri-operative outcomes, hence all 3 can be viable options for tissue retrieval. However, the longest operative times were for the minilaparotomy approach.…”