title: A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy.
abstract: BACKGROUND
  Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures.
  
  
  METHODS
  The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies.
  
  
  RESULTS
  The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64-21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256).
  
  
  CONCLUSIONS
  Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.
authors.affiliation: Kantonsspital Münsterlingen, Spitalcampus 1, Postfach 100, CH-8596, Münsterlingen, Switzerland. stefan.rimbach@stgag.ch.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rimbach
authors.affiliation: Department of Obstetrics and Gynecology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria.
authors.forename: Annette
authors.initials: A
authors.lastname: Holzknecht
authors.affiliation: Institute of Pathology, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
authors.forename: Constanze
authors.initials: C
authors.lastname: Nemes
authors.affiliation: Institute of Pathology, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
authors.forename: Felix
authors.initials: F
authors.lastname: Offner
authors.affiliation: Department of Obstetrics and Gynecology, University of Timisoara, Timisoara, Romania.
authors.forename: Marius
authors.initials: M
authors.lastname: Craina
mesh_terms: D000818:Animals; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D000069577:Morcellation / Q000295:instrumentation*; D061646:Operative Time; D010537:Peritoneum / Q000473:pathology; D015203:Reproducibility of Results; D013552:Swine; D063186:Uterine Myomectomy / Q000295:instrumentation* / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Hysterectomy; In-bag morcellation; Laparoscopy; Myomectomy; Power morcellation; Retrieval bag