Laparoscopic In-Bag Morcellation Compared with Conventional Morcellation of Myomas and Uterus with Myomas

Abstract

Study objective: To evaluate contained bag electromechanical morcellation for removal of myomas and uterus with myomas, laparoscopically (Study group B), and compare it with uncontained laparoscopic morcellation (Control group A) in patients with similar parameters done earlier.

Design: Retrospective Cohort Comparative Study (Canadian Task Force 2-1).

Setting: Advanced Gynaecologic MAS, university recognized tertiary centre, Mumbai, India.

Patients: 720 women had laparoscopic removal of myomas or large uterus with myomas during a study period of 6 years (from 13 May 2012 to 14 August 2018) with contained bag electromechanical or conventional morcellation.

Interventions: Laparoscopic hysterectomy, laparoscopic myomectomy, conventional uncontained morcellation, contained in-bag morcellation.

Main outcomes measures: Laparoscopic contained in-bag morcellation was compared with conventional morcellation of myomas and uterus with large myomas during a study period of 6 years. Parameters assessed were operating time, time for insertion of bag, morcellation of tissues and removal of bag, blood loss, complications, conversion to open surgery and histopathologic findings of tissues. In Group A, in the first 3 years, 355 women underwent uncontained morcellation. Myoma size and weight varied from 5 cm to 26 cm and 200 g to 3740 g respectively. The myoma number ranged from 1 to 18. No case of leiomyosarcoma was reported. In Group B, in the next 3 years, 365 women underwent contained bag morcellation in 196 myomectomy cases and 169 hysterectomy cases. Myoma size and weight varied from 4 cm to 20 cm and 200 g to 2100 g respectively. The number of myomas varied from 1 to 17.

Results and conclusion: Laparoscopic contained bag morcellation for myomas and uterus with large myomas were evaluated. In myomectomy group both conventional and in bag laparoscopic morcellation were comparable in terms of duration of the surgery and blood loss. When all cases ( hysterectomy and myomectomy combined together) and cases of hysterectomy with large fibroid were studied, laparoscopic in bag morcellation took less operative time and there was statistically significant difference in operative time . No case of leiomyosarcoma was found in our study of 720 cases of myomas or uterus with large myomas.

Keywords: Contained morcellation; Hysterectomy; In bag morcellation; Morcellation; Myoma; Myomectomy.

Fig. 1

Stomach-shaped multiport bag with ear-like tail

Fig. 2

Bag edge introduced with sheath through left lower port

Fig. 3

Specimen placed into bag and bag edges drawn over the specimen

Fig. 4

Flower-like mouth of bag retrieved through left lower port

Fig. 5

Ear-shaped tail rail-roaded into umbilical cannula

Fig. 6

Cannula re-introduced into opening in the tail and insufflation started

Fig. 7

Morcellation of myoma or uterus done within bag which replaces peritoneal cavity

Fig. 8

Morcellation of multiple myoma in bag

Fig. 9

Large specimen of 1.83 kg post-morcellation in bag

Fig. 10

Opening in tail secured with knot below and bag can be withdrawn

Fig. 11

Bag being pulled from left lower port with tail receding into the umbilicus

Fig. 12

Bag filled with methylene blue to test for spillage and integrity check