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Abdominal Approaches to Tissue Containment and Extraction in Minimally Invasive Gynecologic Surgery
Gaby N Moawad1, David Samuel1, Elias D Abi Khalil1
1Department of Obstetrics and Gynecology, The George Washington University, Washington, DC.
Study Objective:
To show different abdominal methods of tissue containment and specimen extraction techniques as an alternative to electromechanical morcellation (EMM).
Design:
A stepwise surgical tutorial using a narrated video (Canadian Task Force classification III).
Setting:
An academic tertiary care hospital.
Interventions:
Minimally invasive gynecologic surgery requires the extraction of large tissue specimens through small incisions. EMM was largely used until recently when the Food and Drug Administration issued a statement on its safety. In this video, we present alternative techniques to EMM as well as different methods of tissue containment. Uteri specimens are contained using a 3M Steri-Drape isolation bag (3M Healthcare, Maplewood, MN) and, alternatively, the Alexis Containment Extraction System (Applied Medical, Rancho Santa Margarita, CA). The contained specimen is manually extracted through the 2.5-cm umbilical port incision using the paper roll technique described here.
Conclusion:
These techniques for tissue containment and extraction provide an alternative to EMM. They allow the minimally invasive surgeon to contain and retrieve large specimens. When used appropriately, these techniques can decrease conversion rates to open abdominal surgery. They are easily reproducible with a minimal learning curve.
