title: A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy.
abstract: BACKGROUND
  Total laparoscopic hysterectomy (TLH) is becoming an increasingly popular treatment in endometrial cancer. Intra-abdominal or vaginal uterus morcellation are well described and routinely practiced techniques in removing a benign bulky uterus but contraindicated in endometrial cancer. In malignancy, the uterus needs to be removed intact to avoid intraperitoneal spillage of the endometrial cancer cells, and a uterine size of 12 gestational weeks (g.w.) or larger has been considered a contraindication for the laparoscopic approach. The aim of our study was to evaluate the feasibility and safety of a sealed vaginal morcellation technique in a bag for endometrial cancer laparoscopic treatment.
  
  
  METHODS
  We prospectively scheduled 12 patients affected by endometrial cancer with uterus bigger than 12 g.w. for endometrial cancer laparoscopic treatment. After performing TLH, a sterile plastic wrapping bag was inserted by a 12 mm camera port by rolling it onto the blunt probe. The uterus was covered from the fundus to the cervix, placing the free edges of the bag down into the manipulator cup with two blunt graspers. The specimen completely covered by the bag was then pushed down under direct laparoscopic vision through colpotomy and pulled out from the vagina. The uterus was morcellated by the vaginal route.
  
  
  RESULTS
  All patients underwent laparoscopic treatment with vaginal uterine morcellation. The mean uterus weight was 290.8 ± 79.7 g with a mean morcellation operative time of 12.1 min. All vaginal morcellations were completed successfully. All patients were without evidence of local or distant recurrence at the median follow-up time of 18 months.
  
  
  CONCLUSIONS
  This technique allows the surgeon to morcellate a bulky uterus in cases of endometrial cancer and reduces the chance of neoplastic cell spillage during debulking at TLH. Vaginal morcellation following oncologic rules permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies.
authors.affiliation: Department of Gynecology and Obstetrics, "SS. Antonio e Biagio e Cesare Arrigo" Hospital, Via Venezia 16, 15100, Alessandria, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Montella
authors.forename: Francesca
authors.initials: F
authors.lastname: Riboni
authors.forename: Stefano
authors.initials: S
authors.lastname: Cosma
authors.forename: Davide
authors.initials: D
authors.lastname: Dealberti
authors.forename: Stefano
authors.initials: S
authors.lastname: Prigione
authors.forename: Carla
authors.initials: C
authors.lastname: Pisani
authors.forename: Enrico
authors.initials: E
authors.lastname: Rovetta
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods*; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009929:Organ Size; D010865:Pilot Projects; D011446:Prospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging / Q000473:pathology