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Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes.
J Minim Invasive Gynecol. 2015 Mar-Apr; 22(3):433-8.JM

Abstract

STUDY OBJECTIVE

To compare perioperative outcomes, particularly operative time, between uncontained and in-bag power morcellation of uterine tissue at the time of laparoscopic surgery.

DESIGN

Canadian Task Force classification II-3.

SETTING

Academic tertiary care hospitals.

PATIENTS

Women undergoing laparoscopic hysterectomy or myomectomy who required morcellation of uterine tissue for specimen extraction.

INTERVENTIONS

Outcomes among patients who had in-bag power morcellation were compared with outcomes among patients who had traditional power morcellation. The technique for in-bag morcellation entails placing the specimen into a large containment bag within the abdomen, insufflating the bag within the peritoneal cavity, and then using a power morcellator to remove the specimen from inside the bag.

MEASUREMENTS AND MAIN RESULTS

The cohort consisted of 85 consecutive patients who underwent surgery with morcellation of uterine tissue. Prospective data collected from 36 patients who underwent in-bag morcellation were compared with retrospective data collected from the immediately preceding 49 patients who had uncontained power morcellation. Baseline demographics were comparable between the 2 groups although women who underwent in-bag morcellation were on average older than the open morcellation group (mean age in years [standard deviation], 49.19 [1.12] vs 44.06 [8.93]; p = .01). The mean operating room time was longer in the in-bag morcellation group (mean time in minutes [standard deviation], 119.0 [55.91] vs 93.13 [44.90]; p = .02). The estimated blood loss, specimen weight, hospital length of stay, and perioperative complication rate did not vary between the 2 groups. Operative times did not vary significantly by surgeon. There were no cases of malignancy or isolation bag disruption.

CONCLUSIONS

In-bag power morcellation, a tissue extraction technique developed to reduce the risk of tissue dissemination, results in perioperative outcomes comparable with the traditional laparoscopic approach. In this cohort, the mean operative time was prolonged by 26 minutes with in-bag morcellation but may potentially be reduced with further refinement of the technique.

Authors+Show Affiliations

Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: vickyvar55@gmail.com.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

25452122

Citation

Vargas, Maria V., et al. "Open Power Morcellation Versus Contained Power Morcellation Within an Insufflated Isolation Bag: Comparison of Perioperative Outcomes." Journal of Minimally Invasive Gynecology, vol. 22, no. 3, 2015, pp. 433-8.
Vargas MV, Cohen SL, Fuchs-Weizman N, et al. Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol. 2015;22(3):433-8.
Vargas, M. V., Cohen, S. L., Fuchs-Weizman, N., Wang, K. C., Manoucheri, E., Vitonis, A. F., & Einarsson, J. I. (2015). Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. Journal of Minimally Invasive Gynecology, 22(3), 433-8. https://doi.org/10.1016/j.jmig.2014.11.010
Vargas MV, et al. Open Power Morcellation Versus Contained Power Morcellation Within an Insufflated Isolation Bag: Comparison of Perioperative Outcomes. J Minim Invasive Gynecol. 2015 Mar-Apr;22(3):433-8. PubMed PMID: 25452122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. AU - Vargas,Maria V, AU - Cohen,Sarah L, AU - Fuchs-Weizman,Noga, AU - Wang,Karen C, AU - Manoucheri,Elmira, AU - Vitonis,Allison F, AU - Einarsson,Jon I, Y1 - 2014/11/29/ PY - 2014/10/02/received PY - 2014/11/21/revised PY - 2014/11/22/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/9/1/medline KW - Hysterectomy KW - In-bag morcellation KW - Laparoscopy KW - Morcellation KW - Myomectomy KW - Tissue extraction SP - 433 EP - 8 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 22 IS - 3 N2 - STUDY OBJECTIVE: To compare perioperative outcomes, particularly operative time, between uncontained and in-bag power morcellation of uterine tissue at the time of laparoscopic surgery. DESIGN: Canadian Task Force classification II-3. SETTING: Academic tertiary care hospitals. PATIENTS: Women undergoing laparoscopic hysterectomy or myomectomy who required morcellation of uterine tissue for specimen extraction. INTERVENTIONS: Outcomes among patients who had in-bag power morcellation were compared with outcomes among patients who had traditional power morcellation. The technique for in-bag morcellation entails placing the specimen into a large containment bag within the abdomen, insufflating the bag within the peritoneal cavity, and then using a power morcellator to remove the specimen from inside the bag. MEASUREMENTS AND MAIN RESULTS: The cohort consisted of 85 consecutive patients who underwent surgery with morcellation of uterine tissue. Prospective data collected from 36 patients who underwent in-bag morcellation were compared with retrospective data collected from the immediately preceding 49 patients who had uncontained power morcellation. Baseline demographics were comparable between the 2 groups although women who underwent in-bag morcellation were on average older than the open morcellation group (mean age in years [standard deviation], 49.19 [1.12] vs 44.06 [8.93]; p = .01). The mean operating room time was longer in the in-bag morcellation group (mean time in minutes [standard deviation], 119.0 [55.91] vs 93.13 [44.90]; p = .02). The estimated blood loss, specimen weight, hospital length of stay, and perioperative complication rate did not vary between the 2 groups. Operative times did not vary significantly by surgeon. There were no cases of malignancy or isolation bag disruption. CONCLUSIONS: In-bag power morcellation, a tissue extraction technique developed to reduce the risk of tissue dissemination, results in perioperative outcomes comparable with the traditional laparoscopic approach. In this cohort, the mean operative time was prolonged by 26 minutes with in-bag morcellation but may potentially be reduced with further refinement of the technique. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/25452122/Open_power_morcellation_versus_contained_power_morcellation_within_an_insufflated_isolation_bag:_comparison_of_perioperative_outcomes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(14)01540-4 DB - PRIME DP - Unbound Medicine ER -