Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters.
BACKGROUND
Safe tissue removal is a challenge for minimally invasive procedures such as myomectomy, supracervical hysterectomy, or total hysterectomy of a large uterine specimen. There is concern regarding disruption or dissemination of tissue during this process, which may be of particular significance in cases of undetected malignancy. Contained tissue extraction techniques have been developed in an effort to mitigate morcellation-related risks.


OBJECTIVE
The objective of the study was to quantify perioperative outcomes of contained tissue extraction using power morcellation, specifically evaluating parameters of tissue or fluid leakage from within the containment system.


METHODS
This was a study including a multicenter prospective cohort of adult women who underwent minimally invasive hysterectomy or myomectomy using a contained power morcellation technique. Blue dye was applied to the tissue specimen prior to removal to help identify cases of fluid or tissue leakage from within the containment system.


RESULTS
A total of 76 patients successfully underwent the contained power morcellation protocol. Mean time for the contained morcellation procedure was 30.2 minutes (±22.4). The mean hysterectomy specimen weight was 480.1 g (±359.1), and mean myomectomy specimen weight was 239.1 g (±229.7). The vast majority of patients (73.7%) were discharged home the same day of surgery. Final pathological diagnosis was benign in all cases. Spillage of dye or tissue was noted in 7 cases (9.2%), although containment bags were intact in each of these instances.


CONCLUSIONS
Findings are consistent with prior work demonstrating the feasibility of contained tissue extraction; however, further refinement of this technique is warranted.
Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: scohen20@partners.org.
Sarah L
SL
Cohen
Division of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, MA.
Stephanie N
SN
Morris
Center for Minimally Invasive Gynecologic Surgery, Massachusetts General Hospital, Boston, MA.
Doug N
DN
Brown
Department of Gynecology, Brigham and Women's Faulkner Hospital, Boston, MA.
James A
JA
Greenberg
Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA.
Brian W
BW
Walsh
Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA.
Antonio R
AR
Gargiulo
Division of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, MA.
Keith B
KB
Isaacson
Department of Gynecology, Lahey Hospital and Medical Center, Burlington, MA.
Kelly N
KN
Wright
Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA.
Serene S
SS
Srouji
Division of Reproductive Endocrinology and Infertility, Brigham and Women's Hospital, Boston, MA.
Raymond M
RM
Anchan
Department of Gynecology, Lahey Hospital and Medical Center, Burlington, MA.
Alison B
AB
Vogell
Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA.
Jon I
JI
Einarsson
D000328:Adult; D015331:Cohort Studies; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D000069577:Morcellation / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D047368:Tumor Burden; D014591:Uterine Diseases / Q000601:surgery; D063186:Uterine Myomectomy / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*
D004396:Coloring Agents
hysterectomy; in-bag morcellation; laparoscopic surgery; myomectomy