Laparoscopic In-Bag Morcellation Compared with Conventional Morcellation of Myomas and Uterus with Myomas

Abstract

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.

Rate of Leiomyosarcomas during Surgery for Uterine Fibroids: 8-Year Experience of a Single Center

“…However, it is important to keep in mind that there are no data to support myomectomy with in-bag morcellation in suspicious uterine fibroids for malignancy. Further studies are needed to establish its effectiveness and safety for LMS cases [41] despite the fact that the majority of studies have shown comparable results in terms of surgery duration and blood loss [42].…”

Contained Power Morcellation in Laparoscopic Uterine Myoma Surgeries: A Brief Review

“…Introduction of the bag and its deployment lasted 1.5 ± 1 min, placement of the specimen 4.7 ± 5.7 min, extraction of the bag’s large opening 2.7 ± 1 min, entering the optic trocar while establishing the pseudoperitoneum 5.6 ± 4.3 min, inserting the morcellation device 1.3 ± 0,7 min, and closing and removing the containment bag 1.9 ± 0.7 min [ 63 ]. Subsequent studies on contained morcellation with the application of dual-opening systems reported the time related to bag use as ranging from 7 to 22 min [ 84 , 85 , 86 , 87 ]. Other reports revealed that contained morcellation prolongs the total time of the operation by about 20–30 min compared to the retrospective control group [ 76 , 78 , 88 ].…”

“…According to published studies, the weight of the surgical specimen subjected to contained morcellation varied from 18 to 2805 g [ 63 , 64 , 65 , 82 , 87 ]. The size of the specimen can be a real limitation of the use of the retrieval bag.…”

“…Adverse events associated with bag use seem to be very rare. Numerous studies report no complications [ 63 , 64 , 65 , 82 , 87 ]. Only one study revealed minor complications in two of 33 patients (6%).…”