title: Preclinical safety testing for morcellation and extraction for an endobag with sealable ports: in vitro pilot study.
abstract: Electromechanical power morcellation is an important tool of modern laparoscopy. Recent reports on the spread of previously undetected malignancy by power morcellation indicate the need for additional protective devices to reduce this risk. We conducted a study to obtain the first data concerning the safety of an endobag with three closable ports during morcellation and subsequent bag extraction under in vitro conditions, mimicking the settings in our operating theater. The second purpose of the study was to establish a minimal width of the skin incision necessary to safely extract the sealed bag after morcellation.
  
  
  
  The morcellation test was carried out on 11 stained porcine muscle tissue samples with one additional sample as a control. The insufflation pressure was set at 12 mmHg. After filling the endobag with blue dye solution, an additional extraction test was conducted by pulling the closed bag through a template with apertures of various diameters. For each opening, a series of ten bag extractions was carried out.
  
  
  
  No loss of solid material or fluid was recorded during the morcellation test. The extraction test showed a loss of fluid for template openings smaller than 18 mm. The force necessary to extract the bag was inversely related to the width of the aperture.
  
  
  
  The data suggest that under the evaluated conditions, the use of a closable morcellation bag can considerably improve the patient's safety during morcellation. Further studies are necessary to evaluate the influence of the bag on operating time, intervention costs and complications.
authors.affiliation: Department of Obstetrics and Gynecology, Community Hospital Dormagen, Dr.-Geldmacher-St. 20, 41540, Dormagen, Germany. michael.anapolski@kkh-ne.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Anapolski
authors.affiliation: Department of Obstetrics and Gynecology, Community Hospital Dormagen, Dr.-Geldmacher-St. 20, 41540, Dormagen, Germany.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Panayotopoulos
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alkatout
authors.affiliation: Department of Anesthesiology, Community Hospital Dormagen, Dormagen, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Soltesz
authors.affiliation: Department of Obstetrics and Gynecology, University Witten/Herdecke, Witten, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Schiermeier
authors.affiliation: Department of Obstetrics and Gynecology, Community Hospital Dormagen, University of Witten-Herdecke, Dormagen, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Noé
mesh_terms: D000818:Animals; D005260:Female; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D007327:Insufflation; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D007889:Leiomyoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008953:Models, Anatomic; D000069577:Morcellation / Q000295:instrumentation* / Q000379:methods; D061646:Operative Time; D010865:Pilot Projects; D012449:Safety; D012509:Sarcoma / Q000150:complications / Q000473:pathology; D013552:Swine; D063186:Uterine Myomectomy / Q000295:instrumentation* / Q000379:methods; D014594:Uterine Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*
keywords: In-bag morcellation; Intracorporeal morcellation; Myoma; Power morcellation; Sarcoma