Power Morcellation Using a Contained Bag System

Abstract

Background and Objectives:The well-known advantages of minimally invasive surgery make the approach well suited for hysterectomy and other gynecological procedures. The removal of specimens excised during surgery has been a challenge that has been answered by the use of power morcellation. With this study we sought to assess the feasibility of power morcellation within a specimen bag.Methods:This was a retrospective cohort study including patients from a private practice in suburban Chicago, Illinois, who underwent contained electromechanical power morcellation during a laparoscopic or robot-assisted hysterectomy or myomectomy from May 2014 through December 2015. Contained power morcellation was performed with the Espiner EcoSac 230 (Espiner Medical Ltd., North Somerset, United Kingdom) specimen bag. Descriptive statistics were performed for both categorical and continuous data.Results:Of the 187 procedures performed, 73.8% were myomectomies, and 26.2% were hysterectomies. The patients' mean age was 40 (range, 25–54) years and mean body mass index was 28.7 (range, 17.3–57.6). The average specimen weight was 300 g, with the largest weighing 2134 g. Estimated blood loss averaged 98.4 mL. The postoperative admission rate was 12.3%, most of which were due to nausea and urinary retention. Seventeen patients (9.1%) had postoperative complications, most of which were minor, and 4 (2.1%) were readmitted. There were no bag failures or complications that were due to the use of the specimen bag or to power morcellation.Conclusions:Performing electromechanical power morcellation within the Espiner EcoSac 230 specimen bag was successfully performed in 187 patients with no bag-related complications. This method of contained power morcellation is feasible, reliable, and reproducible, even for a large specimen.

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

“…However, an in vitro study demonstrated that the risk of leakage and tissue dissemination still exists, depending on the insufflation pressure and material type of the bag [53], and the case of Süleyman Salman confirmed this issue [54]. Another in vivo study showed that some types of bags seem to be safe [55], [56], but the existing bags were not designed for power morcellation and, thus, risk spillage in the case of multiport laparoscopy. The authors of that study suggested that the absence of leakage be assessed by visual inspection.…”

A Novel Multi-Port Containment System for Laparoscopic Power Morcellation to Prevent Tumoral Spread: A Retrospective Cohort Study

“…Therefore, in this study, we reported an NMC system with the aim of realizing the integration of the containment bag and laparoscopic trocars to form a completely sealed containment barrier that prevents the spillage of liquids and tissue from the time the uterine tissue is morcellated and encapsulated in the system. Several protected techniques by using endobag systems for UL power morcellation have been described in the literatures (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Although these technologies can play a protective role, there are still three major shortcomings.…”

Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports

“…However, the usage of containment bags is limited to a determined uterine weight[ 27 ]. At this regard, a study reported successful in-bag contained procedures of power morcellation for samples varying from 300 to 2134 g, with no bag rupture or bag-associated complications[ 14 ]. To date, few studies tested the use of in-bag contained extracorporeal manual morcellation for large uteri after TLH, with the largest specimen weighing 1930 g[ 20 , 28 ].…”

“…Such procedure was firstly described by Shibley[ 9 ] that used power morcellation to remove a uterus inside a bowel isolation bag. Different authors described feasible variants of such procedure, without major complications[ 10 - 14 ]. Retrospective studies showed that contained power morcellation necessitates an extra operative time of 20-26 minutes in comparison to uncontained power morcellation, with similar postoperative results[ 15 , 16 ].…”