Feasibility of Washings at the Time of Laparoscopic Power Morcellation: A Pilot Study

Abstract

Study objective: To determine the feasibility and role of abdominopelvic washings at the time of laparoscopic power morcellation and to determine if endometrial or myometrial tissue will be detected before and after laparoscopic power morcellation.

Design: A prospective pilot study (Canadian Task Force classification II-3).

Setting: An academic medical center.

Patients: All women who underwent laparoscopic myomectomy by a single provider at Northwestern Prentice Women's Hospital between August 2014 and October 2015.

Interventions: Abdominopelvic washings were performed before and after laparoscopic power morcellation in a specimen bag. Washings were evaluated for the presence of intra-abdominal endometrial or myometrial tissue using cell block and cytospin techniques.

Measurements and main results: A total of 13 cases were performed. Eleven subjects underwent multiport laparoscopy, and 2 underwent laparoendoscopic single-site surgery. Morcellation was performed within a 15 mm Tissue Retrieval System 100SB2 (Anchor Products, Addison, IL). Two sets of abdominopelvic washings were performed after completion of myomectomy: one before morcellation and the second after morcellation. As a control, washings of the inside of the empty specimen bag were performed after completion of morcellation in 1 patient. The operative outcomes analyzed included a median specimen weight of 313 g (range, 43-940 g), a median operative time in minutes of 161 minutes (range, 94-243 minutes), and a median estimated blood loss of 200 mL (range, 100-700 mL). There was no visual or cytologic evidence of intra-abdominal dissemination of uterine tissue before or after enclosed morcellation on evaluation by cytospin or cell block techniques. Only the washings from the inside of the specimen bag were found to have myometrial tissue on evaluation using the cell block technique.

Conclusion: Performing abdominopelvic washings at the time of laparoscopic power morcellation is a feasible method by which to evaluate and document the presence or absence of microscopic dissemination, with comparable operative parameters to what is already reported in the literature. When abdominopelvic washings are used as an intermediate outcome measure, enclosed bag morcellation appears to minimize tissue dissemination during laparoscopic power morcellation; however, additional and larger studies are needed.

Keywords: Enclosed morcellation; Laparoscopic morcellation; Myomas.