title: Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study.
abstract: OBJECTIVE
  To evaluate risk of leakage and tissue dissemination associated with various contained tissue extraction (CTE) techniques.
  
  
  METHODS
  In vitro study (Canadian Task Force classification: II-1).
  
  
  METHODS
  Academic hospital simulation laboratory.
  
  
  METHODS
  Beef tongue specimens weighing 400 to 500 g were stained using 5 mL indigo carmine dye and morcellated under laparoscopic guidance within a plastic box trainer. CTE was performed via 3 different techniques: a stitch-sealed rip-stop nylon bag and multi-port approach; a one-piece clear plastic 50 × 50-cm isolation bag and multi-port approach; or a 1-piece clear plastic 50 × 50-cm isolation bag and single-site approach. Four trials of each CTE method were performed and compared with an open morcellation control. All bags were insufflated to within 10 to 25 mmHg pressure with a standard CO2 insufflator. Visual evidence of spilled tissue or dye was recorded, and fluid washings of the box trainer were sent for cytologic analysis.
  
  
  RESULTS
  Blue dye spill was noted in only 1 of 12 CTE trials. Spillage was visualized from a seam in 1 of the 4 stitch-sealed rip-stop nylon bags before morcellation of the specimen. The only trial in which gross tissue chips were visualized in the box trainer after morcellation was the open morcellation control. However, cytologic examination revealed muscle cells in the open morcellation washings and in the washings from the trial with dye spill. Muscle cells were not observed at cytologly in any of the other samples.
  
  
  CONCLUSIONS
  CTE did not result in any leakage or tissue dissemination with use of the single-site or multi-port approach when using a 1-piece clear plastic 50 × 50-cm isolation bag. Further studies are needed to corroborate these findings in an in vivo context and to evaluate use of alternate bag options for specimen containment.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: scohen20@partners.org.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.affiliation: Department of Gynecology, Brigham and Women's Faulkner Hospital, Boston, Massachusetts.
authors.forename: James A
authors.initials: JA
authors.lastname: Greenberg
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Serene S
authors.initials: SS
authors.lastname: Srouji
authors.affiliation: Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Gargiulo
authors.affiliation: Neil and Elise Wallace STRATUUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Pozner
authors.affiliation: Brigham and Women's Hospital Clinical Laboratories, Boston, Massachusetts.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Hoover
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical; D002417:Cattle; D004195:Disease Models, Animal; D066298:In Vitro Techniques; D010535:Laparoscopy / Q000379:methods; D010865:Pilot Projects; D011183:Postoperative Complications / Q000473:pathology*; D013048:Specimen Handling; D014059:Tongue / Q000473:pathology
keywords: Hysterectomy; Laparoscopy; Morcellation; Myomectomy; Tissue extraction