Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study

J Minim Invasive Gynecol. 2019 Nov-Dec;26(7):1351-1356. doi: 10.1016/j.jmig.2019.01.014. Epub 2019 Jan 31.

Abstract

Study objective: Few reports have investigated the use of endoscopic retrieval bags in the context of laparoscopic myomectomy with electromechanical morcellation. We performed a leak test of a specially designed endoscopic bag system in women undergoing laparoscopic myomectomy with contained electromechanical morcellation.

Design classification: Prospective study.

Setting: University hospital.

Patients: Thirty-one women undergoing laparoscopic myomectomy with contained electromechanical morcellation.

Interventions: Electromechanical morcellation was introduced for large specimen extraction during laparoscopic procedures. Complications such as retained/disseminated parasitic tissue were documented.

Measurements and main results: Systematic peritoneal washings were performed at 3 specific times: at baseline, T1, once the peritoneal cavity was accessed laparoscopically; T2, when the myometrial incision was closed after myomectomy; and T3, after contained electromechanical morcellation. After retrieval of the endoscopic bag from the abdominal cavity, visual inspection and water test on the bag with NaCl infiltration were performed to detect leaks attributed to intraoperative perforations. A pathologist performed cytologic analyses on the 3 washings. The mean endoscopic bag procedure duration was 9 minutes. The use of a specially designed endoscopic bag system was found to be easy in 45% of cases, and no complications were reported. Cytologic washings were positive for smooth muscle cell detection in 8 cases (25.8%) at T2 and 3 cases (9.7%) at T3. All positive cases at T3 already had detectable smooth muscle cells at T2. After retrieval from the abdominal cavity, perforations on the optic access of the endoscopic bag were observed in 3 cases.

Conclusion: The results from this pilot study are encouraging. The use of a specially designed endoscopic bag system could be an adjuvant to reduce the risk of disseminating cells during myomectomy.

Keywords: Electromechanical morcellation; Endoscopic bag; Laparoscopic myomectomy; Minimally invasive surgery.

MeSH terms

  • Adult
  • Containment of Biohazards / instrumentation*
  • Equipment Failure
  • Female
  • Humans
  • Laparoscopy / methods*
  • Morcellation / instrumentation*
  • Morcellation / methods
  • Peritoneal Cavity / pathology*
  • Pilot Projects
  • Prospective Studies
  • Uterine Myomectomy / methods*
  • Uterine Neoplasms / surgery*