Power Morcellation in a Specimen Bag

A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy

“…Earlier reports used bags at volumes between 1000 and 3100 ml [44,[47][48][49][50]. The bag presented here provides a capacity of 2500 ml, which proved suitable to establish a pseudo-pneumoperitoneum totally comparable to clinical routine.…”

“…Several approaches have been described in gynecology to date using different ways of bag insertion, morcellation and tissue extraction. These include abdominal port site [44][45][46][47][48][49] or transvaginal [50] insertion of the bag, open abdominal (mini-laparotomic) [49] or vaginal in-bag morcellation [51][52][53][54][55], each manually under direct vision, and laparoscopic power morcellation within a pseudo-pneumoperitoneum in the bag inside the abdomen [44][45][46][47][48][49][50]. The latter technique provides the possibility of containing morcellation, when vaginal access is not suitable.…”

“…After bag insertion into the peritoneal space, the specimen is positioned in the bag via this mouth and the same exteriorized onto the abdominal wall, thus following the principles of usual retrieval bags [44,47,48]. The challenge at this point is to provide safe morcellation which requires access for the morcellator device, enough space and visual control.…”

“…Multiport approach requires at least one puncture of the intraperitoneally insufflated bag in all so far published systems [44][45][46][47][48][49][50]. Puncturing the bag, however, carries the risk of leakage and spilling, and thus opposes the intent of contained morcellation [21,23,25,26,56].…”

“…Systems requiring bag puncture achieve to prevent spilling from the puncture hole by using a balloon tip trocar [44][45][46][47][48][49][50]. Our system provides at this point an intact closed, contained environment for subsequent morcellation.…”