title: First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy.
abstract: Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy.
  
  
  
  The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation.
  
  
  
  Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation.
  
  
  
  The experiences from our small pilot series prove technical feasibility in the clinical setting.
authors.affiliation: Department of Obstetrics and Gynecology, Kantonsspital Münsterlingen, Spitalcampus 1, 8596, Münsterlingen, Switzerland. stefan-rimbach@t-online.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rimbach
authors.affiliation: Department of Obstetrics and Gynecology, Landeskrankenhaus Feldkirch, 6800, Feldkirch, Austria.
authors.forename: Annette
authors.initials: A
authors.lastname: Holzknecht
authors.affiliation: Department of Obstetrics and Gynecology, Landeskrankenhaus Feldkirch, 6800, Feldkirch, Austria.
authors.forename: Claudia
authors.initials: C
authors.lastname: Schmedler
authors.affiliation: Institute of Pathology, Landeskrankenhaus Feldkirch, 6800, Feldkirch, Austria.
authors.forename: Constanze
authors.initials: C
authors.lastname: Nemes
authors.affiliation: Institute of Pathology, Landeskrankenhaus Feldkirch, 6800, Feldkirch, Austria.
authors.forename: Felix
authors.initials: F
authors.lastname: Offner
mesh_terms: D001317:Austria; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D010535:Laparoscopy; D008875:Middle Aged; D000069577:Morcellation / Q000295:instrumentation* / Q000379:methods; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D063186:Uterine Myomectomy / Q000295:instrumentation / Q000379:methods*
keywords: Hysterectomy; In-bag morcellation; Laparoscopy; Myomectomy; Power morcellation; Retrieval bag