title: Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes.
abstract: OBJECTIVE
  To compare perioperative outcomes, particularly operative time, between uncontained and in-bag power morcellation of uterine tissue at the time of laparoscopic surgery.
  
  
  METHODS
  Canadian Task Force classification II-3.
  
  
  METHODS
  Academic tertiary care hospitals.
  
  
  METHODS
  Women undergoing laparoscopic hysterectomy or myomectomy who required morcellation of uterine tissue for specimen extraction.
  
  
  METHODS
  Outcomes among patients who had in-bag power morcellation were compared with outcomes among patients who had traditional power morcellation. The technique for in-bag morcellation entails placing the specimen into a large containment bag within the abdomen, insufflating the bag within the peritoneal cavity, and then using a power morcellator to remove the specimen from inside the bag.
  
  
  RESULTS
  The cohort consisted of 85 consecutive patients who underwent surgery with morcellation of uterine tissue. Prospective data collected from 36 patients who underwent in-bag morcellation were compared with retrospective data collected from the immediately preceding 49 patients who had uncontained power morcellation. Baseline demographics were comparable between the 2 groups although women who underwent in-bag morcellation were on average older than the open morcellation group (mean age in years [standard deviation], 49.19 [1.12] vs 44.06 [8.93]; p = .01). The mean operating room time was longer in the in-bag morcellation group (mean time in minutes [standard deviation], 119.0 [55.91] vs 93.13 [44.90]; p = .02). The estimated blood loss, specimen weight, hospital length of stay, and perioperative complication rate did not vary between the 2 groups. Operative times did not vary significantly by surgeon. There were no cases of malignancy or isolation bag disruption.
  
  
  CONCLUSIONS
  In-bag power morcellation, a tissue extraction technique developed to reduce the risk of tissue dissemination, results in perioperative outcomes comparable with the traditional laparoscopic approach. In this cohort, the mean operative time was prolonged by 26 minutes with in-bag morcellation but may potentially be reduced with further refinement of the technique.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: vickyvar55@gmail.com.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Vargas
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Noga
authors.initials: N
authors.lastname: Fuchs-Weizman
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elmira
authors.initials: E
authors.lastname: Manoucheri
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Allison F
authors.initials: AF
authors.lastname: Vitonis
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D007327:Insufflation / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008404:Massachusetts; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D010529:Peritoneal Cavity / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000379:methods; D014594:Uterine Neoplasms / Q000601:surgery
keywords: Hysterectomy; In-bag morcellation; Laparoscopy; Morcellation; Myomectomy; Tissue extraction