A New In-Bag System to Reduce the Risk of Tissue Morcellation: Development and Experimental Evaluation During Laparoscopic Hysterectomy

Arch Gynecol Obstet. 2015 Dec;292(6):1311-20. doi: 10.1007/s00404-015-3788-9. Epub 2015 Jun 21.


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.

Keywords: Hysterectomy; In-bag morcellation; Laparoscopy; Myomectomy; Power morcellation; Retrieval bag.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Case-Control Studies
  • Female
  • Humans
  • Hysterectomy* / instrumentation
  • Hysterectomy* / methods
  • Laparoscopy / methods*
  • Morcellation / instrumentation*
  • Operative Time
  • Peritoneum / pathology
  • Reproducibility of Results
  • Swine
  • Uterine Myomectomy / instrumentation*
  • Uterine Myomectomy / methods*
  • Uterine Neoplasms / surgery*