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The Sydney Contained In Bag Morcellation technique.
Joanne B McKenna1, Trupti Kanade1, Sarah Choi1
1Sydney Women's Endosurgical Centre, Kogarah, New South Wales, Australia.
Journal of Minimally Invasive Gynecology
|July 23, 2014
Summary
This study introduces the Sydney Contained in Bag Morcellation technique to safely remove large fibroid uteri after laparoscopic hysterectomy. It minimizes the risk of spreading cancerous cells during power morcellation procedures.
Area of Science:
- Minimally Invasive Gynecologic Surgery
- Surgical Oncology
- Laparoscopic Hysterectomy Techniques
Background:
- Concerns exist regarding the dissemination of occult leiomyosarcoma during power morcellation of uterine fibroids.
- Traditional morcellation techniques pose a risk of spreading cancerous myoma fragments within the abdominal cavity.
- There is a need for contained morcellation methods during laparoscopic hysterectomy for large myomatous uteri.
Purpose of the Study:
- To demonstrate a modified Shibley single-port technique for contained morcellation of large myomatous uteri.
- To introduce the
- Sydney Contained in Bag Morcellation
- technique to minimize the risk of disseminating myoma fragments.
- To provide a safe and effective method for morcellating large uteri after total laparoscopic hysterectomy.
Main Methods:
- A modified sterile plastic bag with stay sutures and a modified drawstring is introduced into the abdominal cavity.
- The bag is inserted via a McCartney tube, with stay sutures retrieved and exteriorized for bag opening.
- After hysterectomy, the uterus is placed in the bag, which is then exteriorized through the umbilical port for contained morcellation.
Main Results:
- The Sydney Contained in Bag Morcellation technique effectively contains large myomatous uteri during laparoscopic hysterectomy.
- The technique allows for morcellation of uteri weighing up to 978g in a contained environment.
- Facilitation of bag opening and orientation is achieved through stay sutures and a modified drawstring.
Conclusions:
- The Sydney Contained in Bag Morcellation technique offers a viable solution to the risk of disseminating benign and potentially malignant myoma fragments.
- Key procedural aspects, including stay sutures and the McCartney tube, are crucial for successful bag manipulation and insertion.
- This technique provides an alternative to vaginal morcellation, offering improved visualization and the capacity to manage large uteri during laparoscopic procedures.
