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Erschienen in: Archives of Gynecology and Obstetrics 1/2016

21.12.2015 | General Gynecology

First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy

verfasst von: Stefan Rimbach, Annette Holzknecht, Claudia Schmedler, Constanze Nemes, Felix Offner

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 1/2016

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Abstract

Introduction

Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy.

Materials and methods

The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation.

Results

Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation.

Conclusion

The experiences from our small pilot series prove technical feasibility in the clinical setting.
Literatur
1.
Zurück zum Zitat Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev (3):CD003677. doi:10.1002/14651858.CD003677.pub4 Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB (2009) Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev (3):CD003677. doi:10.​1002/​14651858.​CD003677.​pub4
2.
3.
Zurück zum Zitat Steiner RA, Wight E, Tadir Y, Haller U (1993) Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 81(3):471–474PubMed Steiner RA, Wight E, Tadir Y, Haller U (1993) Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 81(3):471–474PubMed
6.
Zurück zum Zitat Tan-Kim J, Hartzell KA, Reinsch CS, O’Day CH, Kennedy JS, Menefee SA, Harrison TA (2014) Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol. doi:10.1016/j.ajog.2014.12.002 PubMed Tan-Kim J, Hartzell KA, Reinsch CS, O’Day CH, Kennedy JS, Menefee SA, Harrison TA (2014) Uterine sarcomas and parasitic myomas after laparoscopic hysterectomy with power morcellation. Am J Obstet Gynecol. doi:10.​1016/​j.​ajog.​2014.​12.​002 PubMed
7.
Zurück zum Zitat Lieng M, Berner E, Busund B (2015) Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J Minim Invasive Gynecol 22(3):410–414. doi:10.1016/j.jmig.2014.10.022 CrossRefPubMed Lieng M, Berner E, Busund B (2015) Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J Minim Invasive Gynecol 22(3):410–414. doi:10.​1016/​j.​jmig.​2014.​10.​022 CrossRefPubMed
14.
Zurück zum Zitat Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, Sawalhe S, van den Haak L, Jansen FW, Pijnenborg J, Taran FA, Brucker S, Wattiez A, Campo R, O’Donovan P, de Wilde RL (2015) European Society of Gynaecological Endoscopy (ESGE) steering committee on fibroid morcellation. Options on fibroid morcellation: a literature review. Gynecol Surg 12(1):3–15CrossRefPubMedPubMedCentral Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, Sawalhe S, van den Haak L, Jansen FW, Pijnenborg J, Taran FA, Brucker S, Wattiez A, Campo R, O’Donovan P, de Wilde RL (2015) European Society of Gynaecological Endoscopy (ESGE) steering committee on fibroid morcellation. Options on fibroid morcellation: a literature review. Gynecol Surg 12(1):3–15CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Beckmann MW, Juhasz-Böss I, Denschlag D, Gaß P, Dimpfl T, Harter P, Mallmann P, Renner SP, Rimbach S, Runnebaum I, Untch M, Brucker SY, Wallwiener D (2015) Surgical methods for the treatment of uterine fibroids—risk of uterine sarcoma and problems of morcellation: position paper of the DGGG. Geburtshilfe Frauenheilkd 75(2):148–164CrossRefPubMedPubMedCentral Beckmann MW, Juhasz-Böss I, Denschlag D, Gaß P, Dimpfl T, Harter P, Mallmann P, Renner SP, Rimbach S, Runnebaum I, Untch M, Brucker SY, Wallwiener D (2015) Surgical methods for the treatment of uterine fibroids—risk of uterine sarcoma and problems of morcellation: position paper of the DGGG. Geburtshilfe Frauenheilkd 75(2):148–164CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Lieng M, Berner E, Busund B (2015) Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J Minim Invasive Gynecol 22(3):410–414. doi:10.1016/j.jmig.2014.10.022 CrossRefPubMed Lieng M, Berner E, Busund B (2015) Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J Minim Invasive Gynecol 22(3):410–414. doi:10.​1016/​j.​jmig.​2014.​10.​022 CrossRefPubMed
17.
Zurück zum Zitat Oduyebo T, Hinchcliff E, Meserve EE, Seidman MA, Quade BJ, Rauh-Hain JA, George S, Nucci MR, Del Carmen MG, Muto MG (2015) Risk factors for occult uterine sarcoma among women undergoing minimally invasive gynecologic surgery. J Minim Invasive Gynecol. doi:10.1016/j.jmig.2015.07.017 PubMed Oduyebo T, Hinchcliff E, Meserve EE, Seidman MA, Quade BJ, Rauh-Hain JA, George S, Nucci MR, Del Carmen MG, Muto MG (2015) Risk factors for occult uterine sarcoma among women undergoing minimally invasive gynecologic surgery. J Minim Invasive Gynecol. doi:10.​1016/​j.​jmig.​2015.​07.​017 PubMed
20.
Zurück zum Zitat Picerno TM, Wasson MN,Gonzalez Rios AR, Zuber MJ, Taylor NP, Hoffman MK, Borowsky ME (2016) Morcellation and the incidence of occult uterine malignancy: a dual-institution review. Int J Gynecol Cancer 26(1):149–155. doi:10.1097/IGC.0000000000000558 CrossRefPubMed Picerno TM, Wasson MN,Gonzalez Rios AR, Zuber MJ, Taylor NP, Hoffman MK, Borowsky ME (2016) Morcellation and the incidence of occult uterine malignancy: a dual-institution review. Int J Gynecol Cancer  26(1):149–155. doi:10.​1097/​IGC.​0000000000000558​ CrossRefPubMed
21.
Zurück zum Zitat Tan A, Salfinger S, Tan J, Cohen P (2015) Morcellation of occult uterine malignancies: an Australian single institution retrospective study. Aust N Z J Obstet Gynaecol 55(5):503–506. doi:10.1111/ajo.12401 CrossRefPubMed Tan A, Salfinger S, Tan J, Cohen P (2015) Morcellation of occult uterine malignancies: an Australian single institution retrospective study. Aust N Z J Obstet Gynaecol 55(5):503–506. doi:10.​1111/​ajo.​12401 CrossRefPubMed
23.
Zurück zum Zitat Hilger WS, Magrina JF (2006) Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy. Obstet Gynecol 108(3 Pt 2):772–774CrossRefPubMed Hilger WS, Magrina JF (2006) Removal of pelvic leiomyomata and endometriosis five years after supracervical hysterectomy. Obstet Gynecol 108(3 Pt 2):772–774CrossRefPubMed
24.
Zurück zum Zitat Donnez O, Squifflet J, Leconte I, Jadoul P, Donnez J (2007) Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies. J Minim Invasive Gynecol 14(2):156–160CrossRefPubMed Donnez O, Squifflet J, Leconte I, Jadoul P, Donnez J (2007) Posthysterectomy pelvic adenomyotic masses observed in 8 cases out of a series of 1405 laparoscopic subtotal hysterectomies. J Minim Invasive Gynecol 14(2):156–160CrossRefPubMed
25.
Zurück zum Zitat Pereira N, Buchanan TR, Wishall KM, Kim SH, Grias I, Richard SD, Della Badia CR (2015) Electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures. J Minim Invasive Gynecol. 22(2):163–176. doi:10.1016/j.jmig.2014.09.006 CrossRefPubMed Pereira N, Buchanan TR, Wishall KM, Kim SH, Grias I, Richard SD, Della Badia CR (2015) Electric morcellation-related reoperations after laparoscopic myomectomy and nonmyomectomy procedures. J Minim Invasive Gynecol. 22(2):163–176. doi:10.​1016/​j.​jmig.​2014.​09.​006 CrossRefPubMed
28.
Zurück zum Zitat AAGL Advancing Minimally Invasive Gynecology Worldwide (2014) AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol 21(4):517–530. doi:10.1016/j.jmig.2014.05.010 AAGL Advancing Minimally Invasive Gynecology Worldwide (2014) AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol 21(4):517–530. doi:10.​1016/​j.​jmig.​2014.​05.​010
29.
Zurück zum Zitat Singh SS, Scott S, Bougie O, Leyland N; SOGC Clinical Practice-Gynaecology Committee, Leyland N, Wolfman W, Allaire C, Awadalla A, Bullen A, Burnett M, Goldstein S, Lemyre M, Marcoux V, Potestio F, Rittenberg D, Singh SS, Yeung G; GOC Executive Committee, Hoskins P, Miller D, Gotlieb W, Bernardini M, Hopkins L (2015) Technical update on tissue morcellation during gynaecologic surgery: its uses, complications, and risks of unsuspected malignancy. J Obstet Gynaecol Can 37(1):68–81. Erratum in: J Obstet Gynaecol Can 2015; 37(2):107 Singh SS, Scott S, Bougie O, Leyland N; SOGC Clinical Practice-Gynaecology Committee, Leyland N, Wolfman W, Allaire C, Awadalla A, Bullen A, Burnett M, Goldstein S, Lemyre M, Marcoux V, Potestio F, Rittenberg D, Singh SS, Yeung G; GOC Executive Committee, Hoskins P, Miller D, Gotlieb W, Bernardini M, Hopkins L (2015) Technical update on tissue morcellation during gynaecologic surgery: its uses, complications, and risks of unsuspected malignancy. J Obstet Gynaecol Can 37(1):68–81. Erratum in: J Obstet Gynaecol Can 2015; 37(2):107
33.
Zurück zum Zitat Rimbach S, Holzknecht A, Nemes C, Offner F, Craina M (2015) A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy. Arch Gynecol Obstet 292(6):1311–1320. doi:10.1007/s00404-015-3788-9 CrossRefPubMed Rimbach S, Holzknecht A, Nemes C, Offner F, Craina M (2015) A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy. Arch Gynecol Obstet 292(6):1311–1320. doi:10.​1007/​s00404-015-3788-9 CrossRefPubMed
34.
35.
Zurück zum Zitat Favero G, Miglino G, Köhler C, Pfiffer T, Silva E, Silva A, Ribeiro A, Le X, Anton C, Baracat EC, Carvalho JP (2015) Vaginal morcellation inside protective pouch: a safe strategy for uterine extration in cases of bulky endometrial cancers. Operative and oncological safety of the method. J Minim Invasive Gynecol. doi:10.1016/j.jmig.2015.04.015 Favero G, Miglino G, Köhler C, Pfiffer T, Silva E, Silva A, Ribeiro A, Le X, Anton C, Baracat EC, Carvalho JP (2015) Vaginal morcellation inside protective pouch: a safe strategy for uterine extration in cases of bulky endometrial cancers. Operative and oncological safety of the method. J Minim Invasive Gynecol. doi:10.​1016/​j.​jmig.​2015.​04.​015
36.
Zurück zum Zitat Montella F, Riboni F, Cosma S, Dealberti D, Prigione S, Pisani C, Rovetta E (2014) A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy. Surg Endosc 28(6):1949–1953. doi:10.1007/s00464-014-3422-0 CrossRefPubMed Montella F, Riboni F, Cosma S, Dealberti D, Prigione S, Pisani C, Rovetta E (2014) A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy. Surg Endosc 28(6):1949–1953. doi:10.​1007/​s00464-014-3422-0 CrossRefPubMed
42.
Zurück zum Zitat Cohen SL, Morris SN, Brown DN, Greenberg JA, Walsh BW, Gargiulo AR, Isaacson KB, Wright K, Srouji SS, Anchan RM, Vogell AB, Einarsson JI (2015) Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol. doi:10.1016/j.ajog.2015.08.076 Cohen SL, Morris SN, Brown DN, Greenberg JA, Walsh BW, Gargiulo AR, Isaacson KB, Wright K, Srouji SS, Anchan RM, Vogell AB, Einarsson JI (2015) Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol. doi:10.​1016/​j.​ajog.​2015.​08.​076
43.
Zurück zum Zitat Kondrup JD, Anderson F, Sylvester B, Branning M (2014) Laparoscopic morcellation and tissue spillage containment using the LI Endofield™ bag. Surg Technol Int 25:162–166PubMed Kondrup JD, Anderson F, Sylvester B, Branning M (2014) Laparoscopic morcellation and tissue spillage containment using the LI Endofield™ bag. Surg Technol Int 25:162–166PubMed
47.
Zurück zum Zitat Vargas MV, Cohen SL, Fuchs-Weizman N, Wang KC, Manoucheri E, Vitonis AF, Einarsson JI (2015) Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol 22(3):433–438. doi:10.1016/j.jmig.2014.11.010 CrossRefPubMed Vargas MV, Cohen SL, Fuchs-Weizman N, Wang KC, Manoucheri E, Vitonis AF, Einarsson JI (2015) Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol 22(3):433–438. doi:10.​1016/​j.​jmig.​2014.​11.​010 CrossRefPubMed
49.
Zurück zum Zitat Shibley KA (2012) Feasibility of intra-abdominal tissue isolation and extraction, within an artificially created pneumoperitoneum, at laparoscopy for gynecologic procedures. J Minim Invasive Gynecol 19:S75CrossRef Shibley KA (2012) Feasibility of intra-abdominal tissue isolation and extraction, within an artificially created pneumoperitoneum, at laparoscopy for gynecologic procedures. J Minim Invasive Gynecol 19:S75CrossRef
Metadaten
Titel
First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy
verfasst von
Stefan Rimbach
Annette Holzknecht
Claudia Schmedler
Constanze Nemes
Felix Offner
Publikationsdatum
21.12.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 1/2016
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-015-3986-5

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