Laparoscopic Power Morcellation: Techniques to Avoid Tumoral Spread

Area of Science:

• Minimally Invasive Surgery
• Gynecologic Oncology
• Surgical Techniques

Background:

• Laparoscopic morcellation allows minimally invasive removal of large specimens, benefiting patients ineligible for traditional laparotomy.
• A significant risk of morcellation is the dissemination of unsuspected malignancies, with uterine sarcoma prevalence estimated between 1 in 305 to 1 in 750 women.
• Regulatory bodies recommend contained morcellation using endobags to mitigate dissemination risks.

Purpose of the Study:

• To present three distinct endobag morcellation techniques for laparoscopic surgery.
• To demonstrate these techniques without increasing surgical time or cost.
• To provide a visual guide through narrated video footage.

Main Methods:

• Indirect-view morcellation: specimen bagged, exteriorized, and morcellated through the bag opening with limited visualization.
• Direct-view morcellation: bag exteriorized through suprapubic and umbilical trocars, allowing direct visualization of morcellation.
• Single-port-contained morcellation: bag exteriorized through the umbilicus, using fingers as trocars for the morcellator and camera.

Main Results:

• All three presented techniques offer feasible methods for contained uterine myoma morcellation.
• Each technique has specific limitations, such as visualization challenges or the need for experienced handling, to ensure containment.
• The methods aim to prevent specimen dissemination during laparoscopic procedures.

Conclusions:

• Laparoscopic power morcellation offers benefits for hysterectomy and myomectomy when performed with containment.
• Three feasible endobag morcellation techniques are presented, adaptable to different surgical scenarios.
• These techniques enhance patient safety by reducing the risk of malignancy spread during minimally invasive surgery.