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In-Bag Manual Extraction of Excised Myomas by Surgical Scalpel through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy.
J Minim Invasive Gynecol. 2016 Jul-Aug; 23(5):731-8.JM

Abstract

STUDY OBJECTIVE

To evaluate the safety and feasibility of in-bag manual extraction for the retrieval of excised myomas through a suprapubic mini-laparotomic incision in 2-port laparoscopic-assisted myomectomy.

DESIGN

Retrospective comparative study (Canadian Task Force classification II-2).

SETTING

Departments of obstetrics and gynecology and diagnostic pathology at a general hospital.

PATIENTS

Twenty-six patients undergoing open manual extraction and 26 patients undergoing in-bag manual extraction by surgical scalpel for the retrieval of excised myomas through a suprapubic mini-laparotomic incision in 2-port laparoscopic-assisted myomectomy.

INTERVENTIONS

In patients with open manual extraction, myoma tissues were directly morcellated in an uncontained setting, whereas in patients managed by in-bag manual extraction, enucleated myomas were put into a retriever bag and then were morcellated by a surgical scalpel while monitoring bag damage by the leakage of indigo carmine dye filled in a bag. The patient demographics and surgical outcome measures were compared between the 2 groups. In the initial 15 patients with in-bag manual extraction, the macroscopic myoma fragments retained in the bag were collected and removed after completion of myoma extraction. Then, the bag contents were washed with normal saline and spilled microscopic tissues salvaged by centrifugation. A histologic examination was performed for collected tissue materials to identify the microscopic myoma fragments.

MEASUREMENTS AND MAIN RESULTS

In patient demographics and surgical outcomes, which include excised tissue weight, surgical duration, and estimated intraoperative blood loss, no significant differences could be identified between the 2 groups. Bag rupture as monitored by the leakage of indigo carmine dye in vivo and ex vivo was not observed. In all patients managed by in-bag manual extraction, spilled macroscopic myoma fragments were identified in the bag. Furthermore, histologic examinations of collected bag contents detected microscopic myoma tissues in 53.3% of patients. These results suggest that without closed conditions, these microscopic myoma particles, which could be difficult to completely remove even by rigorous washing of the peritoneal cavity under laparoscopic vision, might be dispersed in the peritoneal cavity and potentially form iatrogenic peritoneal parasitic myomas if they survive and grow.

CONCLUSION

In-bag manual extraction of myoma tissues through a suprapubic mini-laparotomic incision by a surgical scalpel is a feasible alternative to prevent the dispersion of microscopic myoma fragments and to avoid the potential risk of spreading occult malignancy in 2-port laparoscopic-assisted myomectomy.

Authors+Show Affiliations

Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan. Electronic address: gyendoscopy@gmail.com.Diagnostic Pathology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.Department of Obstetrics & Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26946277

Citation

Takeda, Akihiro, et al. "In-Bag Manual Extraction of Excised Myomas By Surgical Scalpel Through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy." Journal of Minimally Invasive Gynecology, vol. 23, no. 5, 2016, pp. 731-8.
Takeda A, Watanabe K, Hayashi S, et al. In-Bag Manual Extraction of Excised Myomas by Surgical Scalpel through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy. J Minim Invasive Gynecol. 2016;23(5):731-8.
Takeda, A., Watanabe, K., Hayashi, S., Imoto, S., & Nakamura, H. (2016). In-Bag Manual Extraction of Excised Myomas by Surgical Scalpel through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy. Journal of Minimally Invasive Gynecology, 23(5), 731-8. https://doi.org/10.1016/j.jmig.2016.02.020
Takeda A, et al. In-Bag Manual Extraction of Excised Myomas By Surgical Scalpel Through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy. J Minim Invasive Gynecol. 2016 Jul-Aug;23(5):731-8. PubMed PMID: 26946277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-Bag Manual Extraction of Excised Myomas by Surgical Scalpel through Suprapubic Mini-Laparotomic Incision in Laparoscopic-Assisted Myomectomy. AU - Takeda,Akihiro, AU - Watanabe,Kazuko, AU - Hayashi,Shotaro, AU - Imoto,Sanae, AU - Nakamura,Hiromi, Y1 - 2016/03/03/ PY - 2015/12/29/received PY - 2016/02/23/revised PY - 2016/02/23/accepted PY - 2016/3/7/entrez PY - 2016/3/8/pubmed PY - 2017/7/14/medline KW - In-bag manual extraction KW - Laparoscopic-assisted myomectomy KW - Myoma extraction KW - Retriever bag KW - Surgical scalpel KW - Wound retractor SP - 731 EP - 8 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 23 IS - 5 N2 - STUDY OBJECTIVE: To evaluate the safety and feasibility of in-bag manual extraction for the retrieval of excised myomas through a suprapubic mini-laparotomic incision in 2-port laparoscopic-assisted myomectomy. DESIGN: Retrospective comparative study (Canadian Task Force classification II-2). SETTING: Departments of obstetrics and gynecology and diagnostic pathology at a general hospital. PATIENTS: Twenty-six patients undergoing open manual extraction and 26 patients undergoing in-bag manual extraction by surgical scalpel for the retrieval of excised myomas through a suprapubic mini-laparotomic incision in 2-port laparoscopic-assisted myomectomy. INTERVENTIONS: In patients with open manual extraction, myoma tissues were directly morcellated in an uncontained setting, whereas in patients managed by in-bag manual extraction, enucleated myomas were put into a retriever bag and then were morcellated by a surgical scalpel while monitoring bag damage by the leakage of indigo carmine dye filled in a bag. The patient demographics and surgical outcome measures were compared between the 2 groups. In the initial 15 patients with in-bag manual extraction, the macroscopic myoma fragments retained in the bag were collected and removed after completion of myoma extraction. Then, the bag contents were washed with normal saline and spilled microscopic tissues salvaged by centrifugation. A histologic examination was performed for collected tissue materials to identify the microscopic myoma fragments. MEASUREMENTS AND MAIN RESULTS: In patient demographics and surgical outcomes, which include excised tissue weight, surgical duration, and estimated intraoperative blood loss, no significant differences could be identified between the 2 groups. Bag rupture as monitored by the leakage of indigo carmine dye in vivo and ex vivo was not observed. In all patients managed by in-bag manual extraction, spilled macroscopic myoma fragments were identified in the bag. Furthermore, histologic examinations of collected bag contents detected microscopic myoma tissues in 53.3% of patients. These results suggest that without closed conditions, these microscopic myoma particles, which could be difficult to completely remove even by rigorous washing of the peritoneal cavity under laparoscopic vision, might be dispersed in the peritoneal cavity and potentially form iatrogenic peritoneal parasitic myomas if they survive and grow. CONCLUSION: In-bag manual extraction of myoma tissues through a suprapubic mini-laparotomic incision by a surgical scalpel is a feasible alternative to prevent the dispersion of microscopic myoma fragments and to avoid the potential risk of spreading occult malignancy in 2-port laparoscopic-assisted myomectomy. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/26946277/In_Bag_Manual_Extraction_of_Excised_Myomas_by_Surgical_Scalpel_through_Suprapubic_Mini_Laparotomic_Incision_in_Laparoscopic_Assisted_Myomectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(16)00123-0 DB - PRIME DP - Unbound Medicine ER -