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Zhao F, Wang W, Ling B, Liang J. Risk of leakage with a new detachable multi-hard-port containment system for power morcellation during gynecologic laparoscopy: An in vitro study. BMC Surg 2023; 23:213. [PMID: 37525186 PMCID: PMC10388515 DOI: 10.1186/s12893-023-02124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 07/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Laparoscopic surgery has been a milestone for minimally invasive surgeries. But safe removal of large uterine tissue is a challenge for minimally invasive procedures, and there still exists concern about the dissemination of benign or occult malignant uterine tissue during the use of the morcellator. Different tissue containment systems have been used in laparoscopic power morcellation. However, a risk of leakage still exists in clinical practice. In this study, we aimed to evaluate leakage and tissue dissemination associated with a new detachable multi-hard-port containment system for tissue removal during laparoscopic myomectomy morcellation. METHODS Beef tongue specimens were stained with methylene blue solution and morcellated in a plastic trainer box under laparoscopic guidance. The morcellation test in vitro conditions comprised two different containment systems to simulate laparoscopic power morcellation, specifically a polyurethane bag with two pipes (control group) and a detachable multi-hard-port containment system (experimental group). Insufflation pressure was set at 14 mmHg. Three methods are used to detect the leakage The procedure times were recorded. Thirty trials were performed using a multi-port approach and the two tissue containment systems. RESULTS The leakage rate was 0.03% (n = 30) for the experimental group and 26.6% (n = 30) for the control group (p < 0.005). Morcellation time was significantly shorter in the experimental group than in the control group (p < 0.001). Median bag introduction time was shorter in the experimental group than in the control group; however, removal time differences were not significant. CONCLUSIONS This study quantified the low leakage rate during morcellation and the improved convenience of operation provided by a new tissue containment system.
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Affiliation(s)
- Fang Zhao
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Wenhui Wang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Bin Ling
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Jing Liang
- Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China.
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Pepin K, Cope A, Einarsson JI, Cellini J, Cohen SL. Safety of Minimally Invasive Tissue Extraction in Myoma Management: A Systematic Review. J Minim Invasive Gynecol 2020; 28:619-643. [PMID: 32977002 DOI: 10.1016/j.jmig.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This review seeks to establish the incidence of adverse outcomes associated with minimally invasive tissue extraction at the time of surgical procedures for myomas. DATA SOURCES Articles published in the following databases without date restrictions: PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews and Trials. Search was conducted on March 25, 2020. METHODS OF STUDY SELECTION Included studies evaluated minimally invasive surgical procedures for uterine myomas involving morcellation. This review did not consider studies of nonuterine tissue morcellation, studies involving uterine procedures other than hysterectomy or myomectomy, studies involving morcellation of known malignancies, nor studies concerning hysteroscopic myomectomy. A total of 695 studies were reviewed, with 185 studies included for analysis. TABULATION, INTEGRATION, AND RESULTS The following variables were extracted: patient demographics, study type, morcellation technique, and adverse outcome category. Adverse outcomes included prolonged operative time, morcellation time, blood loss, direct injury from a morcellator, dissemination of tissue (benign or malignant), and disruption of the pathologic specimen. CONCLUSION Complications related to morcellation are rare; however, there is a great need for higher quality studies to evaluate associated adverse outcomes.
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Affiliation(s)
- Kristen Pepin
- Department of Obstetrics & Gynecology, Weill Cornell Medical Center, New York, New York (Dr. Pepin).
| | - Adela Cope
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
| | - Jon I Einarsson
- Department of Obstetrics & Gynecology, Brigham and Women's Hospital (Dr. Einarsson)
| | - Jacqueline Cellini
- Department of Research & Instruction, Harvard TH Chan School of Public Health (Ms. Cellini), Boston, Massachusetts
| | - Sarah L Cohen
- Department of Obstetrics & Gynecology, The Mayo Clinic, Rochester, Minnesota (Drs. Cope and Cohen)
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Surgical Treatment of Uterine Fibroids Within a Containment System and Without Power Morcellation. Clin Obstet Gynecol 2016; 59:85-92. [PMID: 26670832 DOI: 10.1097/grf.0000000000000168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Increased awareness regarding risks associated with intracorporeal electromechanical, or power, morcellation has urged surgeons to develop alternative methods for tissue extraction that may mitigate some of these risks during surgery. The use of containment systems during laparoscopic procedures has allowed surgeons to continue to offer and perform myomectomies that still benefit from being minimally invasive but which may minimize the risk of inadvertent tissue dispersion. Here, we will review techniques for performing contained tissue fragmentation without the use of a power morcellator.
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Techniques for Laparoscopic Contained Tissue Extraction. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016; 214:257.e1-257.e6. [PMID: 26348384 DOI: 10.1016/j.ajog.2015.08.076] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Safe tissue removal is a challenge for minimally invasive procedures such as myomectomy, supracervical hysterectomy, or total hysterectomy of a large uterine specimen. There is concern regarding disruption or dissemination of tissue during this process, which may be of particular significance in cases of undetected malignancy. Contained tissue extraction techniques have been developed in an effort to mitigate morcellation-related risks. OBJECTIVE The objective of the study was to quantify perioperative outcomes of contained tissue extraction using power morcellation, specifically evaluating parameters of tissue or fluid leakage from within the containment system. STUDY DESIGN This was a study including a multicenter prospective cohort of adult women who underwent minimally invasive hysterectomy or myomectomy using a contained power morcellation technique. Blue dye was applied to the tissue specimen prior to removal to help identify cases of fluid or tissue leakage from within the containment system. RESULTS A total of 76 patients successfully underwent the contained power morcellation protocol. Mean time for the contained morcellation procedure was 30.2 minutes (±22.4). The mean hysterectomy specimen weight was 480.1 g (±359.1), and mean myomectomy specimen weight was 239.1 g (±229.7). The vast majority of patients (73.7%) were discharged home the same day of surgery. Final pathological diagnosis was benign in all cases. Spillage of dye or tissue was noted in 7 cases (9.2%), although containment bags were intact in each of these instances. CONCLUSION Findings are consistent with prior work demonstrating the feasibility of contained tissue extraction; however, further refinement of this technique is warranted.
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Abstract
As more complex cases and larger uterine specimens are able to be managed with minimally invasive surgery, the limitations of tissue retrieval with these methods are of increasing concern. Risks of morcellator-related injury, tissue dissemination, or fragmentation must be weighed against increased morbidity of abdominal approach to hysterectomy. In an effort to mitigate the risks of tissue morcellation, containment system use must be considered when fragmenting a specimen, either with power morcellation or a manual technique via the vagina or minilaparotomy.
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Liu FW, Galvan-Turner VB, Pfaendler KS, Longoria TC, Bristow RE. A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature. Am J Obstet Gynecol 2015; 212:717-24. [PMID: 25582101 DOI: 10.1016/j.ajog.2015.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/19/2014] [Accepted: 01/07/2015] [Indexed: 01/13/2023]
Abstract
Uterine sarcomas are rare uterine malignancies that are difficult to diagnose preoperatively. Because of cases of disseminated sarcoma after laparoscopic hysterectomy, the role of power morcellators in gynecologic surgery has been questioned. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. In this review, we examine the risk of incidental sarcoma at the time of surgery, the quality of the data, the accuracy of clinical and radiologic predictors of uterine sarcoma, and the impact of morcellation on the prognosis of uterine sarcoma.
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Affiliation(s)
- Fong W Liu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA.
| | - Valerie B Galvan-Turner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
| | - Krista S Pfaendler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
| | - Teresa C Longoria
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
| | - Robert E Bristow
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange, CA
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Kho KA, Brown DN, Nezhat CH. Uterine Morcellation in Pelvic Organ Prolapse Procedures. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0114-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
OBJECTIVE To describe a technique for contained power morcellation within an insufflated isolation bag at the time of uterine specimen removal during minimally invasive gynecologic procedures. METHODS Over the study period of January 2013 to April 2014, 73 patients underwent morcellation of the uterus or myomas within an insufflated isolation bag at the time of minimally invasive hysterectomy or myomectomy. This technique involves placing the specimen into a large plastic bag within the abdomen, exteriorizing the opening of the bag, insufflating the bag within the peritoneal cavity, and then using a power morcellator within the bag to remove the specimen in a contained fashion. Procedures were performed at four institutions and included multiport laparoscopy, single-site laparoscopy, multiport robot-assisted laparoscopy, or single-site robot-assisted laparoscopy. Demographic and perioperative characteristics were collected for the cases. RESULTS Surgical specimen morcellation within an insufflated isolation bag was successfully used in all cases. The median operative time was 114 minutes (range 32-380 minutes), median estimated blood loss was 50 mL (range 10-500 mL), and the median specimen weight was 257 g (range 53-1,481 g). There were no complications related to the contained morcellation technique nor was there visual evidence of tissue dissemination outside of the isolation bag. CONCLUSION Morcellation within an insufflated isolation bag is a feasible technique. Methods for morcellating uterine tissue in a contained manner may provide an option to minimize the risks of open power morcellation while preserving the benefits of minimally invasive surgery. LEVEL OF EVIDENCE II.
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Kho KA, Anderson TL, Nezhat CH. Intracorporeal electromechanical tissue morcellation: a critical review and recommendations for clinical practice. Obstet Gynecol 2014; 124:787-793. [PMID: 25198260 PMCID: PMC4377220 DOI: 10.1097/aog.0000000000000448] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Electromechanical morcellators have come under scrutiny with concerns about complications involving iatrogenic dissemination of both benign and malignant tissues. Although the rapidly rotating blade has resulted in morcellator-related vascular and visceral injuries, equally concerning are the multiple reports in the literature demonstrating seeding of the abdominal cavity with tissue fragmented such as leiomyomas, endometriosis, adenomyosis, splenic and ovarian tissues, and occult cancers of the ovaries and uterus. Alternatives to intracorporeal electric morcellation for tissue extirpation through the vagina and through minilaparotomy are feasible, safe, and have been shown to have comparable, if not superior, outcomes without an increased need for laparotomy. Intracorporeal morcellation within a containment bag is another option to minimize the risk of iatrogenic tissue seeding. Patient safety is a priority with balanced goals of maximizing benefits and minimizing harm. When intracorporeal electromechanical morcellation is planned, physicians should discuss the risks and consequences with their patients. Although data are being collected to quantify and understand these risks more clearly, a minimally invasive alternative to unenclosed intracorporeal morcellation is favored when available. It is incumbent on surgeons to communicate the risks of practices and devices and to advocate for continued improvement in surgical instrumentation and techniques.
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Affiliation(s)
- Kimberly A Kho
- Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, and Vanderbilt University School of Medicine, Nashville, Tennessee; and the Atlanta Center for Minimally Invasive Surgery & Reproductive Medicine, Atlanta, Georgia
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Yi C, Li L, Wang X, Liu X. Recurrence of uterine tissue residues after laparoscopic hysterectomy or myomectomy. Pak J Med Sci 2014; 30:1134-6. [PMID: 25225541 PMCID: PMC4163247 DOI: 10.12669/pjms.305.4509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Revised: 11/04/2013] [Accepted: 06/25/2013] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report a new complication after laparoscopic surgery i.e recurrence of endometrium and leiomyoma fragments from uterine tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy. Methods : This study was carried out on three patients with the recurrence of endometrium or leiomyoma fragments from tissue residues after laparoscopic hysterectomy or laparoscopic myomectomy in the First Affiliated Hospital, Yangtze University, China. We also explored the possible reasons and corresponding preventative strategies. RESULTS Small residues of endometrium and leiomyoma fragments could implant into normal tissue anywhere in the peritoneal cavity after laparoscopic myomectomy or laparoscopic hysterectomy. CONCLUSION These cases emphasize the importance of removing every single fragment to prevent the recurrence of endometrium and leiomyoma from tissue residues.
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Affiliation(s)
- Cunjian Yi
- Cunjian Yi, MD, PhD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Li Li
- Li Li, MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiaowen Wang
- Xiaowen Wang, MD , Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
| | - Xiangqiong Liu
- Xiangqiong Liu , MD, Department of Obstetrics and Gynecology, First Affiliated Hospital, Yangtze University, Jingzhou, Hubei Province 434000, P.R. China
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Cohen SL, Greenberg JA, Wang KC, Srouji SS, Gargiulo AR, Pozner CN, Hoover N, Einarsson JI. Risk of Leakage and Tissue Dissemination With Various Contained Tissue Extraction (CTE) Techniques: An in Vitro Pilot Study. J Minim Invasive Gynecol 2014; 21:935-9. [DOI: 10.1016/j.jmig.2014.06.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 05/30/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022]
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Czarkowski K, Chetty N, Berkes E, Hackethal A. Role and Risks of Morcellation Associated with Laparoscopic Management of Myomas. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2014. [DOI: 10.1007/s13669-014-0084-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wertheim R. Letter to the editor. J Minim Invasive Gynecol 2014; 21:499-500. [PMID: 24568782 DOI: 10.1016/j.jmig.2014.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
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Milad MP, Milad EA. Laparoscopic Morcellator-Related Complications. J Minim Invasive Gynecol 2014; 21:486-91. [DOI: 10.1016/j.jmig.2013.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 12/02/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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Driessen SRC, Arkenbout EA, Thurkow AL, Jansen FW. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21:377-83. [PMID: 24462590 DOI: 10.1016/j.jmig.2013.12.121] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 12/16/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To assess all electromechanical morcellators used in gynecology to achieve an objective comparison between them and to make suggestions for improvements in future developments. DESIGN Literature review. INTERVENTION The PubMed, Web of Science, EMBASE, and MAUDE databases were systematically searched for all available literature using the terms "morcellator," "morcellators," "morcellate," "morcellation," and "morcellated." All articles with information on morcellation time and morcellated tissue mass or the calculated morcellation rate of electromechanical morcellators used for gynecologic laparoscopic surgery were included. For general data of an existing morcellator, the manufacturer was contacted and Google was searched. Data for morcellation rate, type of procedure, and general characteristics were compared. MEASUREMENTS AND MAIN RESULTS Seven articles were suitable for analysis, and 11 different morcellators were found. In the past decades the morcellation rate has increased. The described morcellation rate ranged from 6.2 to 40.4 g/min. Motor peeling is currently the fastest working principle. Comparing hysterectomy and myomectomy per device, the Morcellex and Rotocut morcellators demonstrated a higher morcellation rate for myomectomy, 25.9 vs 30 g/min and 28.4 vs 33.1 g/min, respectively, although the X-Tract morcellator showed a higher rate for hysterectomy, 14.2 vs 11.7 g/min. CONCLUSION Over the years, the morcellator has improved with respect to the morcellation rate. However, the morcellation process still has limitations, including tissue scattering, morcellator-related injuries, and the inevitable small blade diameter, which all come at the expense of the morcellation rate and time. Therefore, development of improved morcellators is required, with consideration of the observed limitations.
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Affiliation(s)
- Sara R C Driessen
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ewout A Arkenbout
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Andreas L Thurkow
- Department of Gynecology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands
| | - Frank-Willem Jansen
- Department of Gynecology, Leiden University Medical Center, Leiden, the Netherlands.
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AAGL Practice Report: Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH). J Minim Invasive Gynecol 2014; 21:9-16. [DOI: 10.1016/j.jmig.2013.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/02/2013] [Indexed: 10/26/2022]
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Rabischong B, Beguinot M, Compan C, Bourdel N, Kaemmerlen AG, Pouly JL, Canis M, Mage G, Botchorishvili R. Complication à long terme du morcellement utérin par voie cœlioscopique : les myomes parasitiques iatrogènes. ACTA ACUST UNITED AC 2013; 42:577-84. [DOI: 10.1016/j.jgyn.2013.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/28/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
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Uccella S, Cromi A, Bogani G, Casarin J, Formenti G, Ghezzi F. Systematic Implementation of Laparoscopic Hysterectomy Independent of Uterus Size: Clinical Effect. J Minim Invasive Gynecol 2013; 20:505-16. [DOI: 10.1016/j.jmig.2013.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/12/2013] [Accepted: 02/18/2013] [Indexed: 11/15/2022]
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Turner T, Secord AA, Lowery WJ, Sfakianos G, Lee PS. Metastatic adenocarcinoma after laparoscopic supracervical hysterectomy with morcellation: A case report. GYNECOLOGIC ONCOLOGY CASE REPORTS 2013; 5:19-21. [PMID: 24371686 PMCID: PMC3862316 DOI: 10.1016/j.gynor.2013.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 03/08/2013] [Indexed: 11/25/2022]
Abstract
Uterine morcellation is common in minimally invasive hysterectomy but should be performed with caution due to risk of unsuspected malignancy. Intraoperative techniques should be considered to minimize dissemination of endometrial tissue during morcellation. Strategies to ensure accurate pathologic evaluation of morcellated specimens and to improve preoperative risk stratification before morcellation procedures are necessary.
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Affiliation(s)
- Taylor Turner
- Department of Obstetrics and Gynecology, Duke University Medical Center, USA
| | - Angeles Alvarez Secord
- Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Duke Cancer Institute, USA
| | - William J Lowery
- Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Duke Cancer Institute, USA
| | - Gregory Sfakianos
- Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Duke Cancer Institute, USA
| | - Paula S Lee
- Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, USA ; Duke Cancer Institute, USA
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Sinha R, Sundaram M, Lakhotia S, Kadam P, Rao G, Mahajan C. Parasitic myoma after morcellation. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2012; 1:113-5. [PMID: 22442523 PMCID: PMC3304268 DOI: 10.4103/0974-1216.71612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report an interesting case of parasitic fibroid which developed from a morcellation remnant following laparoscopic myomectomy. The patient presented with incidental finding of pelvic mass in 2005. She underwent laparoscopic myomectomy for a myoma extending from the Pouch of Douglas to both sides of broad ligament. She subsequently presented with abdominal pain 3 years later in 2008. She underwent total laparoscopic hysterectomy with removal of broad ligament fibroids. During her hysterectomy, a right lumbar mass attached to the omentum was detected, which was excised laparoscopically. Histopathology of the mass confirmed it to be consistent with leiomyoma. This mass could probably be a morcellation remnant that has grown to this size taking blood supply from the omentum. We report this case to emphasize that all tissue pieces that are morcellated should be diligently removed. Even small bits displaced into the upper abdomen can result in parasitic fibroids. Thus, it can be concluded that parasitic myomas can arise from morcellated remnants and grow depending on the blood supply.
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Affiliation(s)
- Rakesh Sinha
- Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery (Beams Hospital), Mumbai, India
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Schuster MW, Wheeler TL, Richter HE. Endometriosis after laparoscopic supracervical hysterectomy with uterine morcellation: a case control study. J Minim Invasive Gynecol 2012; 19:183-7. [PMID: 22265051 PMCID: PMC3292633 DOI: 10.1016/j.jmig.2011.09.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/06/2011] [Accepted: 09/08/2011] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To compare the incidence of new-onset endometriosis after laparoscopic supracervical hysterectomy (LSH) with uterine morcellation to traditional routes. DESIGN Single center case-control study (Canadian Task Force classification II-2) of hysterectomies performed from January 2006 through December 2008. PATIENTS Two hundred seventy-seven laparoscopic supracervical hysterectomies with morcellation (cases) and 187 transvaginal or abdominal hysterectomies without morcellation (controls) were performed from January 2006 through December 2008. INTERVENTIONS A total of 464 women underwent hysterectomy, 277 cases via laparoscopic supracervical approach (LSH) with morcellation and 187 performed either transvaginally or abdominally without morcellation. Repeat operative procedures were performed for other benign indications on 16 of 464 (3.5%) patients who had undergone prior hysterectomy. MEASUREMENTS AND MAIN RESULTS One hundred two patients had endometriosis at the time of hysterectomy diagnosed by pathologic evaluation or gross visualization. In those without endometriosis, repeat operative procedures were performed for pain and bleeding in 3.3% (12/362). Sixty percent (3/5) of patients treated with LSH and 28.6% (2/7) of the control group were found to have newly diagnosed endometriosis, conferring a rate of 1.4% (3/217) in the LSH group and 1.4% (2/145) in the control subjects. In patients with endometriosis, repeat operative procedures for pain or bleeding occurred in 2.9% (3/102): 3/60 patients treated with LSH and none in the control group (0/42). Two of these 3 patients undergoing a second surgery had recurrent/continued endometriosis. CONCLUSION Newly diagnosed endometriosis was noted in 1.4% of patients after hysterectomy, with a similar incidence between the LSH and control groups. Reoperation for those with endometriosis at the time of LSH with morcellation was infrequent, but endometriosis was usually found. Further research is needed to delineate risk factors for development of de novo endometriosis after hysterectomy.
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Affiliation(s)
| | - Thomas L. Wheeler
- Department of Obstetrics and Gynecology, UMG Greenville Hospital Systems, Greenville, SC
| | - Holly E. Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
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Larraín D, Rabischong B, Khoo CK, Botchorishvili R, Canis M, Mage G. "Iatrogenic" parasitic myomas: unusual late complication of laparoscopic morcellation procedures. J Minim Invasive Gynecol 2010; 17:719-24. [PMID: 20655285 DOI: 10.1016/j.jmig.2010.05.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/22/2010] [Accepted: 05/28/2010] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To describe our experience in diagnosing and managing parasitic myomas developing as an unexpected late complication of laparoscopic morcellation. DESIGN Observational study (Canadian Task Force classification II-3). SETTING University hospital. PATIENTS Retrospective chart review of all patients found to have parasitic myomas that developed after previous morcellation. INTERVENTION Laparoscopic morcellation. Review of the recent literature correlated with clinical, surgical, and pathologic features of our cases. MEASUREMENTS AND MAIN RESULTS Four patients had heterogeneous pelvic masses after morcellation. In 3 patients, symptoms developed between 2 and 16 years after the primary surgery. One patient had no symptoms, and was referred because of a suspect pelvic mass. Vaginal examination revealed painful pelvic masses in the pouch of Douglas in 2 patients, and painless masses fixed to the vaginal vault and anterior vaginal wall, respectively, in the other 2 patients. Laparoscopic examination confirmed the presence of parasitic masses in 3 patients. In 1 patient, the mass was excised vaginally. Histologic analysis confirmed leiomyoma fragments in all patients. A well-differentiated endometrial carcinoma was incidentally found in 1 patient after hysterectomy. CONCLUSION These masses probably resulted from growth of missed fragments of uterine tissue after previous morcellation, culminating in development of symptomatic iatrogenic parasitic myomas. If morcellation is anticipated or required, exclusion of malignancy is mandatory. Meticulous inspection of the abdominal cavity is necessary after morcellation. In patients with a history of morcellation who have pelvic masses, iatrogenic parasitic myomas should be considered in the differential diagnosis.
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Affiliation(s)
- Demetrio Larraín
- CHU Clermont-Ferrand, CHU Estaing, Department of Obstetrics-Gynecology and Reproductive Medicine, University of Auvergne, Clermont I, Clermont-Ferrand, France.
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Martínez-Zamora MA, Castelo-Branco C, Balasch J, Carmona F. Comparison of a New Reusable Gynecologic Laparoscopic Electric Morcellator with a Disposable Morcellator: a Preliminary Trial. J Minim Invasive Gynecol 2009; 16:595-8. [DOI: 10.1016/j.jmig.2009.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 04/30/2009] [Accepted: 05/13/2009] [Indexed: 11/17/2022]
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Abstract
PURPOSE OF REVIEW The indications, techniques and outcomes of laparoscopic associated hysterectomy and especially total laparoscopic hysterectomy are thoroughly reviewed. RECENT FINDINGS The original technique for total laparoscopic hysterectomy is detailed as it is still applicable. The total laparoscopic hysterectomy operation has not changed to any major degree over the past 15 years. The technique detailed works well and lessens the chance for a ureteral injury. Expansion of the technique has occurred in oncology. Evidence-based studies support the use of vaginal hysterectomy if possible over laparoscopic and abdominal hysterectomy. They also support a laparoscopic approach to hysterectomy over total abdominal hysterectomy. SUMMARY Despite evidence-based studies, gynecologic surgical specialists have been slow to adopt both laparoscopic and vaginal hysterectomy into their practice. This trend may increase in the near future. Adoption of laparoscopic associated hysterectomy has been extremely slow.
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Affiliation(s)
- Harry Reich
- Wilkes Barre General Hospital, Wilkes Barre, Pennsylvania, USA.
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Bibliography. Current world literature. Minimally invasive gynecologic procedures. Curr Opin Obstet Gynecol 2007; 19:402-5. [PMID: 17625426 DOI: 10.1097/gco.0b013e3282ca75fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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