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Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System.
J Obstet Gynaecol Can. 2020 Jul; 42(7):839-845.JO

Abstract

OBJECTIVE

This study sought to report the feasibility and clinical implications of in-bag morcellation for total laparoscopic hysterectomy (TLH).

METHODS

Women who required uterine morcellation during TLH from January 2017 to December 2018 (at the Centre Hospitalier Universitaire de Québec - CHUL, Québec, QC) were included. Women with a preoperative suspicion of malignancy were excluded (Canadian Task Force classification II-2).

RESULTS

During the 2-year study period, uterine morcellation was required in 42% (106 of 252) of women undergoing TLH. Mean uterine weight of morcellated uterus was 541 ± 291 g, with 11 of 106 uteri weighing >1000 g. In-bag morcellation was attempted in 84 of 106 (79%) and successfully performed in 79 of 84 (94%) women. Failures resulted from inability to insert the specimen into the bag or apparent perforation. Uncontained morcellation was chosen for 22 of 106 (21%) women, most of whom underwent vaginal morcellation of the uterus. Total operative time was 40 minutes longer for the in-bag morcellation group (170 ± 48 vs. 130 ± 43 min; P < 0.001), although this difference can be partly explained by the higher mean uterine size compared with the uncontained morcellation group (580 ± 309 vs. 391 ± 122 g; P = 0.01). In a subgroup analysis of 16 women, the mean times of installation and extraction of the bag were estimated to be 17 ± 9 and 4 ± 3 minutes, respectively. Complications were infrequent (2 of 106) and occurred in the in-bag morcellation group.

CONCLUSION

In-bag morcellation is feasible in a high proportion of women undergoing laparoscopic hysterectomy and is associated with an increase in operative time. Larger studies will be required in order to better assess the risk of complications with in-bag morcellation and the potential benefits of this technique, namely, reducing the spread of tissue.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC.Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC.Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC.Department of Obstetrics and Gynaecology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC.Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, QC. Electronic address: sarah.maheux.lacroix@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32273084

Citation

Gil-Gimeno, Ana, et al. "Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System." Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, vol. 42, no. 7, 2020, pp. 839-845.
Gil-Gimeno A, Laberge PY, Lemyre M, et al. Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System. J Obstet Gynaecol Can. 2020;42(7):839-845.
Gil-Gimeno, A., Laberge, P. Y., Lemyre, M., Gorak, E., & Maheux-Lacroix, S. (2020). Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System. Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'obstetrique Et Gynecologie Du Canada : JOGC, 42(7), 839-845. https://doi.org/10.1016/j.jogc.2019.11.004
Gil-Gimeno A, et al. Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System. J Obstet Gynaecol Can. 2020;42(7):839-845. PubMed PMID: 32273084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Morcellation During Total Laparoscopic Hysterectomies: Implications of the Use of a Contained Bag System. AU - Gil-Gimeno,Ana, AU - Laberge,Philippe Y, AU - Lemyre,Madeleine, AU - Gorak,Emilie, AU - Maheux-Lacroix,Sarah, Y1 - 2020/04/06/ PY - 2019/09/01/received PY - 2019/11/03/revised PY - 2019/11/04/accepted PY - 2020/4/11/pubmed PY - 2020/4/11/medline PY - 2020/4/11/entrez KW - complications KW - hysterectomy KW - intraoperative KW - laparoscopy KW - leiomyoma KW - morcellation SP - 839 EP - 845 JF - Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC JO - J Obstet Gynaecol Can VL - 42 IS - 7 N2 - OBJECTIVE: This study sought to report the feasibility and clinical implications of in-bag morcellation for total laparoscopic hysterectomy (TLH). METHODS: Women who required uterine morcellation during TLH from January 2017 to December 2018 (at the Centre Hospitalier Universitaire de Québec - CHUL, Québec, QC) were included. Women with a preoperative suspicion of malignancy were excluded (Canadian Task Force classification II-2). RESULTS: During the 2-year study period, uterine morcellation was required in 42% (106 of 252) of women undergoing TLH. Mean uterine weight of morcellated uterus was 541 ± 291 g, with 11 of 106 uteri weighing >1000 g. In-bag morcellation was attempted in 84 of 106 (79%) and successfully performed in 79 of 84 (94%) women. Failures resulted from inability to insert the specimen into the bag or apparent perforation. Uncontained morcellation was chosen for 22 of 106 (21%) women, most of whom underwent vaginal morcellation of the uterus. Total operative time was 40 minutes longer for the in-bag morcellation group (170 ± 48 vs. 130 ± 43 min; P < 0.001), although this difference can be partly explained by the higher mean uterine size compared with the uncontained morcellation group (580 ± 309 vs. 391 ± 122 g; P = 0.01). In a subgroup analysis of 16 women, the mean times of installation and extraction of the bag were estimated to be 17 ± 9 and 4 ± 3 minutes, respectively. Complications were infrequent (2 of 106) and occurred in the in-bag morcellation group. CONCLUSION: In-bag morcellation is feasible in a high proportion of women undergoing laparoscopic hysterectomy and is associated with an increase in operative time. Larger studies will be required in order to better assess the risk of complications with in-bag morcellation and the potential benefits of this technique, namely, reducing the spread of tissue. SN - 1701-2163 UR - https://www.unboundmedicine.com/medline/citation/32273084/Morcellation_During_Total_Laparoscopic_Hysterectomies:_Implications_of_the_Use_of_a_Contained_Bag_System_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1701-2163(19)30985-5 DB - PRIME DP - Unbound Medicine ER -
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