title: Safe vaginal uterine morcellation following total laparoscopic hysterectomy.
abstract: The minimally invasive approach for hysterectomy with proven benefits and lower morbidity has become the gold standard, even in women with large uterine masses. Most women with a malignant condition present with abnormal vaginal bleeding and/or suspicious imaging such that few are diagnosed by final histopathology after surgery. However, if a malignancy is not diagnosed preoperatively, intraabdominal morcellation for uterus extraction has an increased risk for potential tumor spread and peritoneal metastases, especially in cases of unexpected leiomyosarcoma. We describe a simple method to wrap the uterus in a contained environment with a plastic bag through the posterior vaginal fornix prior to conventional coring morcellation for vaginal extraction in total laparoscopic hysterectomy. We further describe our experience with a risk stratification and treatment algorithm to implement this procedure in daily routine. A video and an illustrating sketch demonstrate the simplicity and safety of the procedure.
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital and University of Bern, Switzerland. Electronic address: andreas.guenthert@luks.ch.
authors.forename: Andreas R
authors.initials: AR
authors.lastname: Günthert
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital of Lucerne, Lucerne, Switzerland.
authors.forename: Corina
authors.initials: C
authors.lastname: Christmann
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital of Lucerne, Lucerne, Switzerland; Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital and University of Bern, Switzerland; Department of Gynecology and Obstetrics, See-Spital Horgen, Switzerland.
authors.forename: Plamen
authors.initials: P
authors.lastname: Kostov
authors.affiliation: Department of Gynecology and Obstetrics, Inselspital, Bern University Hospital and University of Bern, Switzerland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
mesh_terms: D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007890:Leiomyosarcoma / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: morcellation; total laparoscopic hysterectomy; uterine leiomyosarcoma