Stefan Rimbach1, Annette Holzknecht2, Constanze Nemes3, Felix Offner3, Marius Craina4. 1. Kantonsspital Münsterlingen, Spitalcampus 1, Postfach 100, CH-8596, Münsterlingen, Switzerland. stefan.rimbach@stgag.ch. 2. Department of Obstetrics and Gynecology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria. 3. Institute of Pathology, Landeskrankenhaus Feldkirch, Feldkirch, Austria. 4. Department of Obstetrics and Gynecology, University of Timisoara, Timisoara, Romania.
Abstract
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.
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.
Entities:
Keywords:
Hysterectomy; In-bag morcellation; Laparoscopy; Myomectomy; Power morcellation; Retrieval bag
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