Methods of tissue extraction in advanced laparoscopy.

Advances in laparoscopic surgery have revolved not only around new methods of tissue excision and repair, but also around specimen extraction. At the center of these recent advances is the need to be cost-effective and safe. Two particularly important advances in laparoscopic tissue extraction are use of electronic power morcellators, to cut up and remove large masses, and specimen bags to remove the extracted tissue safely. Although morcellators offer tremendous time savings, and can actually reduce the risk of hernia formation because fascia need not be torn or stretched, the use of power morcellators is not without concern. The sharp rotating blade can damage normal organs. Furthermore, one must watch closely so that morcellated specimens are not inadvertently misplaced. Specimen bags are also important, both in malignant and in benign conditions. Ultimately, the problem is spillage of tissue, whether it be cancer cells or products of conception. Although some specimen bags are equipped with self-opening devices, the largest bags must be opened manually.