Power Morcellation Using a Contained Bag System

Abstract

Background and objectives: The well-known advantages of minimally invasive surgery make the approach well suited for hysterectomy and other gynecological procedures. The removal of specimens excised during surgery has been a challenge that has been answered by the use of power morcellation. With this study we sought to assess the feasibility of power morcellation within a specimen bag.

Methods: This was a retrospective cohort study including patients from a private practice in suburban Chicago, Illinois, who underwent contained electromechanical power morcellation during a laparoscopic or robot-assisted hysterectomy or myomectomy from May 2014 through December 2015. Contained power morcellation was performed with the Espiner EcoSac 230 (Espiner Medical Ltd., North Somerset, United Kingdom) specimen bag. Descriptive statistics were performed for both categorical and continuous data.

Results: Of the 187 procedures performed, 73.8% were myomectomies, and 26.2% were hysterectomies. The patients' mean age was 40 (range, 25-54) years and mean body mass index was 28.7 (range, 17.3-57.6). The average specimen weight was 300 g, with the largest weighing 2134 g. Estimated blood loss averaged 98.4 mL. The postoperative admission rate was 12.3%, most of which were due to nausea and urinary retention. Seventeen patients (9.1%) had postoperative complications, most of which were minor, and 4 (2.1%) were readmitted. There were no bag failures or complications that were due to the use of the specimen bag or to power morcellation.

Conclusions: Performing electromechanical power morcellation within the Espiner EcoSac 230 specimen bag was successfully performed in 187 patients with no bag-related complications. This method of contained power morcellation is feasible, reliable, and reproducible, even for a large specimen.

Keywords: Contained morcellation; Leiomyosarcoma; Morcellation; Uterine morcellation.

Figure 1.

The Espiner EcoSac 230 Bag.

Figure 2.

The EcoSac230 bag is inserted through a 12-mm trocar.

Figure 3.

The specimen is placed inside the EcoSac230 bag. The inside of the bag is confirmed by the lack of stitching around the mouth of the bag.

Figure 4.

The Kii Advanced Fixation Sleeve.

Figure 5.

The mouth of the bag is brought up through the umbilical incision.

Figure 6.

The 12-mm trocar is placed into the bag through the umbilical incision. An insufflator is attached to this trocar and the bag is insufflated to a pressure of 25 mm Hg.

Figure 7.

The Kii Advanced Fixation Sleeve is now inserted through the lateral aspect of the bag, and the balloon is inflated and pulled flush with the side of the bag.

Figure 8.

The 12-mm trocar is replaced with the morcellator placed in the bag under direct visualization (extra-abdominal view).

Figure 9.

The 12-mm trocar is replaced with the morcellator into the bag under direct visualization (intra-abdominal view), and morcellation takes place.

Figure 10.

All small morcellated pieces are removed from the bag.

Figure 11.

The Espiner Eco400 T-Sac.