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Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study.
J Minim Invasive Gynecol. 2019 Nov - Dec; 26(7):1351-1356.JM

Abstract

STUDY OBJECTIVE

Few reports have investigated the use of endoscopic retrieval bags in the context of laparoscopic myomectomy with electromechanical morcellation. We performed a leak test of a specially designed endoscopic bag system in women undergoing laparoscopic myomectomy with contained electromechanical morcellation.

DESIGN CLASSIFICATION

Prospective study.

SETTING

University hospital.

PATIENTS

Thirty-one women undergoing laparoscopic myomectomy with contained electromechanical morcellation.

INTERVENTIONS

Electromechanical morcellation was introduced for large specimen extraction during laparoscopic procedures. Complications such as retained/disseminated parasitic tissue were documented.

MEASUREMENTS AND MAIN RESULTS

Systematic peritoneal washings were performed at 3 specific times: at baseline, T1, once the peritoneal cavity was accessed laparoscopically; T2, when the myometrial incision was closed after myomectomy; and T3, after contained electromechanical morcellation. After retrieval of the endoscopic bag from the abdominal cavity, visual inspection and water test on the bag with NaCl infiltration were performed to detect leaks attributed to intraoperative perforations. A pathologist performed cytologic analyses on the 3 washings. The mean endoscopic bag procedure duration was 9 minutes. The use of a specially designed endoscopic bag system was found to be easy in 45% of cases, and no complications were reported. Cytologic washings were positive for smooth muscle cell detection in 8 cases (25.8%) at T2 and 3 cases (9.7%) at T3. All positive cases at T3 already had detectable smooth muscle cells at T2. After retrieval from the abdominal cavity, perforations on the optic access of the endoscopic bag were observed in 3 cases.

CONCLUSION

The results from this pilot study are encouraging. The use of a specially designed endoscopic bag system could be an adjuvant to reduce the risk of disseminating cells during myomectomy.

Authors+Show Affiliations

Department of Gynecology (Drs. Lambat, Pluchino, Petignat, Pinto, and Dubuisson). Electronic address: slambat@hotmail.com.Department of Gynecology (Drs. Lambat, Pluchino, Petignat, Pinto, and Dubuisson).Department of Gynecology (Drs. Lambat, Pluchino, Petignat, Pinto, and Dubuisson).Division of Clinical Pathology (Drs. Tille and Pache).Division of Clinical Pathology (Drs. Tille and Pache).Department of Gynecology (Drs. Lambat, Pluchino, Petignat, Pinto, and Dubuisson).Department of Radiology (Dr. Botsikas), Geneva University Hospitals, Geneva, Switzerland.Department of Gynecology (Drs. Lambat, Pluchino, Petignat, Pinto, and Dubuisson).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30710637

Citation

Lambat Emery, Shahzia, et al. "Cell Spillage After Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study." Journal of Minimally Invasive Gynecology, vol. 26, no. 7, 2019, pp. 1351-1356.
Lambat Emery S, Pluchino N, Petignat P, et al. Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study. J Minim Invasive Gynecol. 2019;26(7):1351-1356.
Lambat Emery, S., Pluchino, N., Petignat, P., Tille, J. C., Pache, J. C., Pinto, J., Botsikas, D., & Dubuisson, J. (2019). Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study. Journal of Minimally Invasive Gynecology, 26(7), 1351-1356. https://doi.org/10.1016/j.jmig.2019.01.014
Lambat Emery S, et al. Cell Spillage After Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study. J Minim Invasive Gynecol. 2019 Nov - Dec;26(7):1351-1356. PubMed PMID: 30710637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cell Spillage after Contained Electromechanical Morcellation Using a Specially Designed In-Bag System for Laparoscopic Myomectomy: Prospective Cohort Pilot Study. AU - Lambat Emery,Shahzia, AU - Pluchino,Nicola, AU - Petignat,Patrick, AU - Tille,Jean-Christophe, AU - Pache,Jean-Claude, AU - Pinto,Joana, AU - Botsikas,Diomidis, AU - Dubuisson,Jean, Y1 - 2019/01/31/ PY - 2018/10/15/received PY - 2019/01/18/revised PY - 2019/01/27/accepted PY - 2019/2/3/pubmed PY - 2020/5/30/medline PY - 2019/2/3/entrez KW - Electromechanical morcellation KW - Endoscopic bag KW - Laparoscopic myomectomy KW - Minimally invasive surgery SP - 1351 EP - 1356 JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol VL - 26 IS - 7 N2 - STUDY OBJECTIVE: Few reports have investigated the use of endoscopic retrieval bags in the context of laparoscopic myomectomy with electromechanical morcellation. We performed a leak test of a specially designed endoscopic bag system in women undergoing laparoscopic myomectomy with contained electromechanical morcellation. DESIGN CLASSIFICATION: Prospective study. SETTING: University hospital. PATIENTS: Thirty-one women undergoing laparoscopic myomectomy with contained electromechanical morcellation. INTERVENTIONS: Electromechanical morcellation was introduced for large specimen extraction during laparoscopic procedures. Complications such as retained/disseminated parasitic tissue were documented. MEASUREMENTS AND MAIN RESULTS: Systematic peritoneal washings were performed at 3 specific times: at baseline, T1, once the peritoneal cavity was accessed laparoscopically; T2, when the myometrial incision was closed after myomectomy; and T3, after contained electromechanical morcellation. After retrieval of the endoscopic bag from the abdominal cavity, visual inspection and water test on the bag with NaCl infiltration were performed to detect leaks attributed to intraoperative perforations. A pathologist performed cytologic analyses on the 3 washings. The mean endoscopic bag procedure duration was 9 minutes. The use of a specially designed endoscopic bag system was found to be easy in 45% of cases, and no complications were reported. Cytologic washings were positive for smooth muscle cell detection in 8 cases (25.8%) at T2 and 3 cases (9.7%) at T3. All positive cases at T3 already had detectable smooth muscle cells at T2. After retrieval from the abdominal cavity, perforations on the optic access of the endoscopic bag were observed in 3 cases. CONCLUSION: The results from this pilot study are encouraging. The use of a specially designed endoscopic bag system could be an adjuvant to reduce the risk of disseminating cells during myomectomy. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/30710637/Cell_Spillage_after_Contained_Electromechanical_Morcellation_Using_a_Specially_Designed_In_Bag_System_for_Laparoscopic_Myomectomy:_Prospective_Cohort_Pilot_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(19)30058-5 DB - PRIME DP - Unbound Medicine ER -