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

Introduction Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may...

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Bibliographic Details
Published in:Archives of gynecology and obstetrics 2015-12, Vol.292 (6), p.1311-1320
Main Authors: Rimbach, Stefan, Holzknecht, Annette, Nemes, Constanze, Offner, Felix, Craina, Marius
Format: Article
Language:English
Subjects:
Animals
Case-Control Studies
Endocrinology
Female
General Gynecology
Gynecology
Human Genetics
Humans
Hysterectomy - instrumentation
Hysterectomy - methods
Laparoscopy
Laparoscopy - methods
Medicine
Medicine & Public Health
Morcellation - instrumentation
Obstetrics/Perinatology/Midwifery
Operative Time
Peritoneum - pathology
Reproducibility of Results
Swine
Uterine Myomectomy - instrumentation
Uterine Myomectomy - methods
Uterine Neoplasms - surgery
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Summary:Introduction Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures. Material and methods The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies. Results The main results on n  = 8 procedures with in-bag morcellation compared to n  = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min ( P  = 0.0052; 95 % confidence interval 4.64–21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag ( P  = 0.0256). Conclusion Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.
ISSN:0932-0067
1432-0711
DOI:10.1007/s00404-015-3788-9