New attempt of transvaginal in- bag morcellation for laparoscopic total hysterectomy

Abstract

Introduction: Power morcellator is useful as a surgical instrument for shredding a specimen during laparoscopic surgery; however, because this technology requires a widened porthole in the abdominal wall, we consider that it has scope for improvement in terms of esthetic outcome and perspective on pain. In addition, at the time of transvaginal removal of the shredded specimen, we often cannot have enough space to perform the removal because the vaginal cavity is narrow and deep; alternatively, it may be difficult to perform owing to the extremely large specimen present. We report here a case of transvaginal in-bag morcellation. Methods: A single hospital observational study that involved patients who underwent laparoscopic hysterectomy was conducted. A folded isolation bag (3M Steri-Drape Isolation Bag) was introduced into the peritoneal cavity, and the specimen was placed in the bag. The mouth of the bag was guided to the vaginal stump and then exteriorized. A smallsized wound retractor, along with the bag, was set at the vaginal cavity, and the hole was covered with a sterile glove. A 5-mm trocar was inserted into the glove for the endoscope, and a morcellator was inserted into the cavity via the glove under observation. We performed transvaginal in-bag morcellation without spillage and dissemination of unwanted cells and tissues. Conclusion: Transvaginal in-bag morcellation performed with our new technique requires neither a widened porthole nor lacerations of the vaginal wall and thus may prove beneficial for esthetic outcome and reducing pain.