Vaginal morcellation: a new strategy for large gynecological malignant tumor extraction: a pilot study.
OBJECTIVE
Evaluate feasibility and safety of a novel technique for uterine morcellation in patients scheduled for laparoscopic treatment of gynecologic malignances.


BACKGROUND
The laparoscopic management of uterine malignancies is progressively gaining importance and popularity over laparotomy. Nevertheless, minimal invasive surgery is of limited use when patients have enlarged uterus or narrow vagina. In these cases, conventional uterus morcellation could be a solution but should not be recommended due to risks of tumor dissemination.


METHODS
Prospective pilot study of women with endometrial cancer in which uterus removal was a realistic concern due to both organ size and proportionality. Brief technique description: after completion of total laparoscopic hysterectomy and bilateral anexectomy, a nylon with polyurethane Lapsac® is vaginally inserted into the abdomen; the specimen is placed inside the pouch that will be closed and rotated 180° toward the vaginal vault and, posteriorly, pushed into the vaginal canal; in the transvaginal phase, the surgeon pulls the edges of the bag up to vaginal introitus and all vaginal walls will be covered; inside the pouch, the operator performs a uterus bisection-morcellation.


RESULTS
In our series of 8 cases, we achieved successful completion in all patients, without conversion to laparotomy. Average operative time, blood loss and length of hospitalization were favorable. One patient presented with a vesicovaginal fistula.


CONCLUSIONS
The vaginal morcellation following oncologic principles is a feasible method that permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies. Further studies are needed to confirm the oncological safety of the technique.
Department of Gynecology, Instituto do Câncer do Estado de São Paulo, ICESP, Faculdade de Medicina da Universidade de São Paulo, Brazil. gdifavero@hotmail.com
Giovanni
G
Favero
Cristina
C
Anton
Alexandre
A
Silva e Silva
Altamiro
A
Ribeiro
Marcia Pereira
MP
Araújo
Giovanni
G
Miglino
Edmund Chada
EC
Baracat
Jesus Paula
JP
Carvalho
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D002296:Carcinosarcoma / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods; D010388:Pelvis; D010865:Pilot Projects; D011446:Prospective Studies; D058994:Salpingectomy / Q000009:adverse effects / Q000379:methods; D014621:Vagina / Q000601:surgery