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Asati P, Asati S, Sinha V, Dixit H, Mahajan A, Alraddadi YK, Syed AK. Evaluation of the Efficacy and Complications of Different Hysterectomy Techniques in the Management of Uterine Fibroids. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S2428-S2430. [PMID: 39346314 PMCID: PMC11426832 DOI: 10.4103/jpbs.jpbs_236_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 03/24/2024] [Accepted: 04/05/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction Uterine fibroids, which are benign tumors affecting a significant proportion of women, often necessitate hysterectomy for suggestive relief. Understanding the relative efficiency and safety profiles of different techniques is crucial for optimizing patient care. Materials and Methods This prospective cohort study enrolled women diagnosed with symptomatic uterine fibroids who underwent hysterectomy. Surgical techniques included "total abdominal hysterectomy (TAH)", "laparoscopic hysterectomy (LH)", and "vaginal hysterectomy (VH)". Efficacy outcomes included operative time, blood loss, and recurrence rates, while complications encompassed intraoperative and postoperative adverse events. Results Laparoscopic hysterectomy demonstrated the shortest operative time and least blood loss compared with TAH and VH. Total abdominal hysterectomy had the highest rates of both intraoperative and postoperative complications, followed by LH and VH. Recurrence rates were comparable among the three techniques. Conclusion Laparoscopic hysterectomy offers advantages in operative efficiency and complication rates compared with total abdominal and vaginal hysterectomy techniques.
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Affiliation(s)
- Pranshi Asati
- Department of Obstetrics and Gynecology, Bundelkhand Medical College, Sagar, Madhya Pradesh, India
| | - Swati Asati
- Department of Obstetrics and Gynecology, Vyas Medical College and Hospital Jodhpur, Rajasthan, India
| | - Varsha Sinha
- Assistant Professor, N.Y Tasgaonkar Institute of Medical Sciences, Karjat, Raigad, Maharashtra, India
| | - Heena Dixit
- Hospital and Healthcare Management, DY Patil Deemed to be University, Navi Mumbai, Maharashtra, India
| | - Akriti Mahajan
- Department of Oral Medicine and Radiology, Private Consultant, Jammu and Kashmir, India
| | - Yasser Khalid Alraddadi
- Department of Medical Microbiology, College of Medicine and Surgery King Abdulaziz University, KSA
| | - Afroz Kalmee Syed
- Department of Oral and Maxillofacial Pathology, Scientific Medical Writer, Tenali, Andhra Pradesh, India
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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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Herman A, Duraiswamy N, Nandy P, Price V, Gibeily G, Hariharan P. Mechanical and leakage integrity testing considerations for evaluating the performance of tissue containment systems. Sci Rep 2023; 13:5104. [PMID: 36991010 PMCID: PMC10060240 DOI: 10.1038/s41598-023-31847-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Tissue containment systems (TCS) are medical devices that may be used during morcellation procedures during minimally invasive laparoscopic surgery. TCS are not new devices but their use as a potential mitigation for the spread of occult malignancy during laparoscopic power morcellation of fibroids and/or the uterus has been the subject of interest following reports of upstaging of previously undetected sarcoma in women who underwent a laparoscopic hysterectomy. Development of standardized test methods and acceptance criteria to evaluate the safety and performance of these devices will speed development, allowing for more devices to benefit patients. As a part of this study, a series of preclinical experimental bench test methods were developed to evaluate the mechanical and leakage performance of TCS that may be used in power morcellation procedures. Experimental tests were developed to evaluate mechanical integrity, e.g., tensile, burst, puncture, and penetration strengths for the TCS, and leakage integrity, e.g., dye and microbiological leakage (both acting as surrogates for blood and cancer cells) through the TCS. In addition, to evaluate both mechanical integrity and leakage integrity as a combined methodology, partial puncture and dye leakage was conducted on the TCS to evaluate the potential for leakage due to partial damage caused by surgical tools. Samples from 7 different TCSs were subjected to preclinical bench testing to evaluate leakage and mechanical performance. The performance of the TCSs varied significantly between different brands. The leakage pressure of the TCS varied between 26 and > 1293 mmHg for the 7 TCS brands. Similarly, the tensile force to failure, burst pressure, and puncture force varied between 14 and 80 MPa, 2 and 78 psi, and 2.5 N and 47 N, respectively. The mechanical failure and leakage performance of the TCS were different for homogeneous and composite TCSs. The test methods reported in this study may facilitate the development and regulatory review of these devices, may help compare TCS performance between devices, and increase provider and patient accessibility to improved tissue containment technologies.
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Affiliation(s)
- Alexander Herman
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA
| | - Nandini Duraiswamy
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA
| | - Poulomi Nandy
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA
| | - Veronica Price
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA
| | - George Gibeily
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA
| | - Prasanna Hariharan
- Center for Devices and Radiological Health, Food & Drug Administration, Silver Spring, MD, USA.
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Laparoscopic subtotal hysterectomy followed by in-bag transvaginal corpus uteri morcellation and extraction: A case series. Eur J Obstet Gynecol Reprod Biol 2023; 282:124-127. [PMID: 36708659 DOI: 10.1016/j.ejogrb.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Laparoscopic subtotal hysterectomy (LSH) is a possible treatment for patients with benign uterine disease. Once the hysterectomy has been completed, morcellation and extraction of the corpus uteri is a crucial step of the procedure. We here present a case series to evaluate the feasibility of the in-bag transvaginal specimen retrieval following LSH. STUDY DESIGN We report a case series of consecutive patients who underwent LSH followed by in-bag transvaginal specimen retrieval. LSH was accomplished in a standard fashion. Once the uterus was detached from the cervix, a 2 cm posterior colpotomy was performed laparoscopically with a monopolar hook under direct view to insert a specimen retrieval bag into the abdomen. The corpus uteri was placed into the bag and transvaginal contained manual morcellation was performed. The colpotomy was then sutured transvaginally. Baseline patients' characteristics and surgical data were collected. Postoperative complications, same-hospital readmissions, and reoperations were registered if occurred within 30 days from surgery. RESULTS Patients' median age and BMI were 45,5 and 22,7, respectively. Median operative time was 71.5 min (range 34-143) and uterus weight ranged from 60 g to 470 g (median 210 g). The estimated blood loss was 100 mL (median) and no blood transfusion was required. No conversions to open surgery, nor intraoperative complications occurred. Median hospital stay was 2 days (1-3) and no postoperative complications within 30 days from surgery were recorded. CONCLUSIONS LSH followed by in-bag transvaginal specimen extraction is a promising technique and might be considered a reliable and safe option to further reduce the invasiveness of the procedure.
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Devassy R, Torres-de la Roche LA, San Juan J, Krentel H, Becker S, De Wilde RL, Soliman A. To Laparoscopically Preserve Fertility in Intraabdominal Giant Myoma with Application of Contained In-Bag Morcellation: Mission Impossible? J Clin Med 2022; 11:4531. [PMID: 35956146 PMCID: PMC9369746 DOI: 10.3390/jcm11154531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023] Open
Abstract
A technical video was produced to demonstrate in step-by-step fashion a multiple contained myomectomy of a 20 × 30 cm giant myoma and seven additional fibroids found in the same patient, which required two different types of specimen retrieval bags for the electronic power morcellation. This complete surgical procedure included leiomyomata enucleation, contained in-bag electronic power morcellation, uterine reconstruction and the application of an adhesion prophylactic medical product.
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Affiliation(s)
- Rajesh Devassy
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Luz Angela Torres-de la Roche
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Johannes San Juan
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Harald Krentel
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Sven Becker
- Gynecologic Oncology and Gynecologic Specialties, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
| | - Amr Soliman
- University Hospital for Gynecology, Pius Hospital, University Medicine Oldenburg, Carl von Ossietzky University, 26121 Oldenburg, Germany; (R.D.); (L.A.T.-d.l.R.); (J.S.J.); (H.K.); (A.S.)
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Mercorio A, Della Corte L, Vetrella M, Russo M, Serafino P, Palumbo M, Viciglione F, Cafasso V, Bifulco G, Giampaolino P. Uterine fibroids morcellation: a puzzle topic. MINIM INVASIV THER 2022; 31:1008-1016. [DOI: 10.1080/13645706.2022.2095872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Antonio Mercorio
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Martino Vetrella
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Mario Russo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Paolo Serafino
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Mario Palumbo
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Francesco Viciglione
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Valeria Cafasso
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences, and Dentistry, School of Medicine, Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Anapolski M, Schellenberger A, Alkatout I, Panayotopoulos D, Gut A, Soltesz S, Schiermeier S, Papathemelis T, Noé GK. Preclinical safety testing and initial experience of a morcellation bag with four sealable ports. Sci Rep 2021; 11:20882. [PMID: 34686761 PMCID: PMC8536670 DOI: 10.1038/s41598-021-99934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
Electromechanical morcellation-so called power morcellation-is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11-24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4-14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20-194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13-896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0-39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.
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Affiliation(s)
- Michael Anapolski
- Department of Obstetrics and Gynecology, Community Hospital Dormagen, University of Witten-Herdecke, Dr.-Geldmacher-St. 20, 41540, Dormagen, Germany.
| | | | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Alexander Gut
- Department of Obstetrics and Gynecology, Community Hospital Grevenbroich, Grevenbroich, Germany
| | - Stefan Soltesz
- Department of Anesthesiology, Community Hospital Dormagen, Dormagen, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Witten, Germany
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, Amberg, Germany
| | - Günter K Noé
- Department of Obstetrics and Gynecology, Community Hospital Dormagen, University of Witten-Herdecke, Dr.-Geldmacher-St. 20, 41540, Dormagen, Germany
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Macciò A, Sanna E, Lavra F, Calò P, Madeddu C. Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports. World J Clin Cases 2021; 9:5655-5660. [PMID: 34307621 PMCID: PMC8281410 DOI: 10.12998/wjcc.v9.i20.5655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the presence of a large uterus, total laparoscopic hysterectomy (TLH), always requires morcellation to allow removal of the tissues from the abdominal cavity. However, uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma. Therefore, in-bag extracorporeal morcellation has been developed. However, tissue containment and extraction are extremely challenging, especially when considering the increasing uterine size to be removed through minimally invasive surgery.
CASE SUMMARY Herein, we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH. The study enrolled patients who were planned for TLH for large uteri (weight > 500 g). TLH was performed following the procedure reported in our previous studies. The novel technique has been described step-by-step in a video, which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g, 1700 g, and 3700 g, respectively. The procedures were performed without any complications. The patients had an uneventful postoperative course, and in all cases, the pathology was benign leiomyoma.
CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies. The technique herein presented may be adopted in surgical practice, by adding it to the other available techniques of contained morcellation. It may represent a valid and feasible alternative, especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecologic Oncology, Businco Hospital, ARNAS G. Brotzu, Cagliari 09100, Italy
| | - Elisabetta Sanna
- Department of Gynecologic Oncology, Businco Hospital, ARNAS G. Brotzu, Cagliari 09100, Italy
| | - Fabrizio Lavra
- Department of Gynecologic Oncology, Businco Hospital, ARNAS G. Brotzu, Cagliari 09100, Italy
| | - Piergiorgio Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari 09100, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari 09100, Italy
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Iatrogenic Port Site Parasitic Myoma; Case Report and Literature Review. Int Surg 2021. [DOI: 10.9738/intsurg-d-15-00104.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction
We report a case of iatrogenic parasitic myoma of the anterior abdominal wall and discuss the differential diagnosis, treatment, and prevention of complication with relevant literature.
Case Report
A 33-year-old woman presented with anterior abdominal wall mass 3 years after initial laparoscopic myomectomy surgery. A mass with a 38 × 26 mm diameter was observed in the anterior abdominal wall at the site of inferior left side port of previous surgery. It was excised from the anterior abdominal wall outside of the peritoneum, below the fascia. The pathologic examination of the excised mass revealed cellular myoma. This case is the 4th port site parasitic myoma in literature.
Conclusion
The risk of implantation and subsequent growth of minute myoma fragments should be kept in mind during morcellation procedures and, in order to avoid such complications, all fragments should be tracked during morcellation. The inspection of trocar sites after the removal of trocars for retained fragments would prevent such recurrences.
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Ahn SH, Park JH, Kim HR, Cho S, Lee M, Seo SK, Choi YS, Lee BS. Robotic single-site versus multi-port myomectomy: a case-control study. BMC Surg 2021; 21:264. [PMID: 34044817 PMCID: PMC8157697 DOI: 10.1186/s12893-021-01245-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/04/2021] [Indexed: 02/01/2023] Open
Abstract
Background This study aimed to evaluate the compatibility of robotic single-site (RSS) myomectomy in comparison with the conventional robotic multi-port (RMP) myomectomy to achieve successful surgical outcomes with reliability and reproducibility. Methods This retrospective case–control study was performed on 236 robotic myomectomies at a university medical center. After 1:1 propensity score matching for the total myoma number, total myoma diameter, and patient age, 90 patients in each group (RSS: n = 90; RMP: n = 90) were evaluated. Patient demographics, preoperative parameters, intraoperative characteristics, and postoperative outcome measures were analyzed. Results The body mass index, parity, preoperative hemoglobin levels, mean maximal myoma diameter, and anatomical type of myoma showed no mean differences between RSS and RMP myomectomies. The RSS group was younger, had lesser number of myomas removed, and had a smaller sum of the maximal diameter of total myomas removed than the RMP group. After propensity score matching, the total operative time (RSS: 150.9 ± 57.1 min vs. RMP: 170 ± 74.5 min, p = 0.0296) was significantly shorter in the RSS group. The RSS group tended to have a longer docking time (RSS: 9.8 ± 6.5 min vs. RMP: 8 ± 6.2 min, p = 0.0527), shorter console time (RSS: 111.1 ± 52.3 min vs. RMP: 125.8 ± 65.1 min, p = 0.0665), and shorter time required for in-bag morcellation (RSS: 30.1 ± 17.2 min vs. RMP: 36.2 ± 25.7 min, p = 0.0684). The visual analog scale pain score 1 day postoperatively was significantly lower in the RSS group (RSS: 2.4 ± 0.8 days vs. RMP: 2.7 ± 0.8 days, p = 0.0149), with similar consumption of analgesic drugs. The rate of transfusion, estimated blood loss during the operation, and length of hospital stay were not different between the two modalities. No other noticeable complications were observed in either group. Conclusions Da Vinci RSS myomectomy is a compatible option with regard to reproducibility and safety, without significantly compromising the number and sum of the maximal diameter of myomas removed. The advantage of shorter total operative time and less pain with the same amount of analgesic drugs in RSS myomectomy will contribute to improving patient satisfaction.
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Affiliation(s)
- So Hyun Ahn
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Joo Hyun Park
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea. .,Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea.
| | - Hye Rim Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - SiHyun Cho
- Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea.,Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Sik Choi
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Seok Lee
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
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Yoshino Y, Yoshiki N, Nakamura R, Iwahara Y, Ishikawa T, Miyasaka N. Large leiomyomatosis peritonealis disseminata after laparoscopic myomectomy: A case report with literature review. Int J Surg Case Rep 2020; 77:866-869. [PMID: 33395914 PMCID: PMC7725661 DOI: 10.1016/j.ijscr.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023] Open
Abstract
Leiomyomatosis peritonealis disseminata (LPD) is a rare disease. LPD is associated with power morcellation during previous laparoscopic myomectomy. Long-term follow-up is necessary to detect LPD, which is not always symptomatic.
Introduction Leiomyomatosis peritonealis disseminata (LPD) is a rare disease in which multiple leiomyomas are formed intraperitoneally. Several LPD cases were associated with laparoscopic myomectomy using power morcellators; however, LPD with a large tumor size remains extremely rare. We present a case of large LPD occurring after laparoscopic surgery. Presentation of case A 26-year-old woman, gravida 0, underwent laparoscopic myomectomy with power morcellation in our institution. After 5 years, follow-up examination revealed pelvic tumors. Although we recommended resection, she refused and only wanted to be followed up. After 9 years from the first surgery, the tumors became symptomatic and were increasing in number (>10 nodules) and size (>15 cm). Needle biopsy detected leiomyoma. Computed tomography angiography showed that omental and mesenteric arteries were feeding the tumors. We performed laparotomy, and all the 19 tumors emerging from the omentum and mesenterium and weighing 7647 g in total were removed without injuring other organs. The maximum diameter of the largest tumor was 34 cm. The pathological diagnosis was nonmalignant LPD with leiomyoma. Discussion Among all reported cases, our case had the largest LPD size. The tumors reached such a huge size because of two possible reasons: (1) they gradually grew asymptomatically over a long period from the time of diagnosis, and (2) they were fed by particularly large vessels, including the omental and mesenteric arteries. Conclusion A large LPD is not always symptomatic. After a laparoscopic myomectomy, especially with power morcellation, long-term follow-up is necessary to detect LPD.
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Affiliation(s)
- Yasunori Yoshino
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Naoyuki Yoshiki
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Reiko Nakamura
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuki Iwahara
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomonori Ishikawa
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Department of Perinatal and Women's Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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12
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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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13
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Anapolski M, Alkatout I, Wedel T, Panayotopoulos D, Soltesz S, Schiermeier S, Papathemelis T, Noé GK. Laparoscopic approaches to the retropubic space: three alternatives with anatomical considerations. MINIM INVASIV THER 2019; 30:154-162. [PMID: 31868557 DOI: 10.1080/13645706.2019.1699115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Many urogynecological and surgical laparoscopic interventions require access to the retropubic space, also known as the space of Retzius. Especially in patients with a history of previous surgery in this area or in general in the lower abdomen, the preparation may be complicated by adhesions and scar tissue. The necessity to combine several laparoscopic procedures in one surgical session may require consideration of the most appropriate way to approach the retropubic space. MATERIAL AND METHODS We describe and discuss three different options to access the space of Retzius via laparoscopy: the medial transperitoneal, the extraperitoneal and the lateral transperitoneal approach. For all approaches, we used one umbilical trocar and two trocars in the lower abdomen. RESULTS An algorithm was developed to select the most appropriate access route to the retropubic space, depending on the history of previous surgeries and accompanying interventions. CONCLUSION The knowledge of different access routes to the retropubic space offers the possibility of adjusting the surgical procedure to the individual constellation of the patient.
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Affiliation(s)
- Michael Anapolski
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Community Hospital Dormagen, Dormagen, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig-Holstein, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts University Kiel, Kiel, Germany
| | | | - Stefan Soltesz
- Department of Anesthesiology, Community Hospital Dormagen, Dormagen, Germany
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Witten, Germany
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, Klinikum St. Marien Amberg, Amberg, Germany
| | - Günter K Noé
- Department of Obstetrics and Gynecology, University of Witten-Herdecke, Community Hospital Dormagen, Dormagen, Germany
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14
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Yang J, Song YJ, Na YJ, Kim HG. Two-port myomectomy using bag-contained manual morcellation: A comparison with three-port myomectomy using power morcellation. Taiwan J Obstet Gynecol 2019; 58:423-427. [PMID: 31122536 DOI: 10.1016/j.tjog.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and safety of two-port myomectomy using bag-contained manual morcellation compared to three-port myomectomy using power morcellation. MATERIAL AND METHODS A retrospective chart review was conducted for 428 cases of either two-port or three-port laparoscopic myomectomy performed by single operator in the university hospital between January 2011 and December 2016. RESULTS The cohorts of three-port myomectomy with power morcellation was consisted of two hundred and forty-eight patients. One hundred and eighty patients underwent two-port myomectomy with manual morcellation in contained bag. Two-port group showed shorter hospital stay (5.16 ± 1.39 d vs. 4.83 ± 1.19 d, p = 0.001), less estimated blood loss (61.8 ± 58.2 mL vs. 50.2 ± 52.4 mL, p = 0.001), and higher hemoglobin level at postoperative day 1 (10.7 ± 1.17 g/dL vs. 11.0 ± 1.14 g/dL, p = 0.028) with statistical significance. Morcellation time (25.8 ± 9.30 min vs. 18.9 ± 10.11 min, p = 0.001) and total operative time (82.4 ± 30.19 min vs. 76.4 ± 25.47 min, p = 0.047) were also significantly shorter in two-port group. There were no identified spillages of fibroids, ruptures of specimen bag during manual morcellation in two-port myomectomy. In both groups, there were no cases of leiomyosarcoma diagnosed postoperatively. CONCLUSION Two-port laparoscopic myomectomy with bag-contained manual morcellation is a feasible and safe alternative for three-port with power morcellation. Its surgical outcomes were shown to be superior to conventional laparoscopic myomectomy according to our study but further evaluation in near future is needed.
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Affiliation(s)
- Juseok Yang
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Hwi Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea.
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15
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Abstract
Fibroid tissue extraction during hysterectomy and myomectomy has become increasingly controversial. A wave of research has tried to clarify difficult questions around the prevalence of occult malignancies, the effect of morcellation on cancer outcomes, proper informed consent, and surgical options for tissue extraction. This review examines the history of these controversies and discusses tissue extraction techniques and continued areas of debate in the field.
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16
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Herman A, Duraiswamy N, Nandy P, Myers MR, Price V, Gibeily G, Hariharan P. In Vitro Leakage Testing of Tissue Containment Bags When Subjected to Power Morcellation Forces. J Minim Invasive Gynecol 2019; 27:655-664. [PMID: 31125722 DOI: 10.1016/j.jmig.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/15/2019] [Accepted: 05/11/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To determine the ability of tissue containment systems to prevent leakage of cancer cell surrogates when subjected to forces encountered during power morcellation procedures. DESIGN In vitro study. SETTING Medical device research laboratory. INTERVENTIONS Samples from 7 different legally marketed tissue containment bags (1 of which is indicated for power morcellation) were subjected to dye and bacteriophage penetration tests at pressures ranging from 0.5 to 50 times the insufflation pressure. The minimum pressure required to cause bag leakage was measured. Subsequently, the morcellation leakage safety factor for each bag was determined as the ratio of the minimum leakage pressure of the bag to the total pressure contributed from insufflation pressure and mechanical forces acting during the power morcellation procedure. MEASUREMENT AND MAIN RESULTS The leakage performance of the bags varied markedly from brand to brand. No correlation was found between leakage pressure and the bag material or the total bag thickness. The leakage pressures ranged from 26 mmHg to >1293 mmHg for the 7 bags, and safety factors ranged from 1 to 50 when only the insufflation pressure was considered. However, if the morcellation forces were included in the calculation, the safety factor dropped by 6-fold for all brands and dropped below 1, indicating likelihood of leakage, for 2 of the 7 brands. CONCLUSION This study provides a mechanism for more realistically simulating the conditions experienced by containment bags during morcellation and quantifying the level of safety provided by the bags.
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Affiliation(s)
- Alexander Herman
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - Nandini Duraiswamy
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - Poulomi Nandy
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - Matthew R Myers
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - Veronica Price
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - George Gibeily
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)
| | - Prasanna Hariharan
- Division of Applied Mechanics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland (all authors), and Office of Product Evaluation and Quality, Center for Devices and Radiological Health, Food and Drug Administration (Ms. Price, Drs. Gibeily and Nandy)..
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Torrent-Colomer A, Reyes Claret A, Vicens-Vidal M, Martin Jiménez A. Parasitic Myomas and Leiomyomatosis Peritonealis Disseminata After Laparoscopic Surgery with Power Morcellation: A Report of Four Cases. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2016.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Torrent-Colomer
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Albert Reyes Claret
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Margalida Vicens-Vidal
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Angel Martin Jiménez
- Department of Gynecology, Son Llàtzer Hospital, Palma de Mallorca, Balearic Islands, Spain
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18
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Aoki Y, Kanao H, Kikuchi I, Nomura H, Okamoto S, Hisa T, Sugihara T, Kitano R, Omatsu K, Tanigawa T, Takeshima N. Comparison of the Technical Feasibility and Safety of Three Contained Morcellation Techniques: A Pilot Study in an Animal Model. J Minim Invasive Gynecol 2018; 26:1288-1296. [PMID: 30562578 DOI: 10.1016/j.jmig.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/05/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To compare 3 laparoscopic contained morcellation techniques in terms of feasibility and safety. DESIGN Pilot study in an animal model (Canadian Task Force classification II-1). SETTING Gynecologic oncology department at a cancer institute in Japan. PATIENTS Porcine model. INTERVENTIONS Three contained morcellation techniques were tested, each multiple times in 1 of 3 anesthetized female pigs: manual morcellation (8 times), dual-site power morcellation (8 times), and single-site power morcellation (6 times). All were tested on beef tongue introduced abdominally. MEASUREMENTS AND MAIN RESULTS The following variables were compared: bag insertion time, morcellation time, bag removal time, total in-bag morcellation time, and the volume of pneumoperitoneum CO2 consumed. Bag rupture was evaluated ex vivo on completion of the procedure. Bag insertion time (in minutes) was significantly greater for dual-site morcellation (10.91 ± 3.38) than for manual (4.58 ± 2.47, p = .003) or single-site power (7.25 ± .77, p = .014) morcellation. Bag removal time (in minutes) was also significantly greater for dual-site morcellation (.85 ± .11 vs .27 ± .14, p<.001, vs .33 ± .59, p = .001). Total in-bag morcellation time, although greatest for manual morcellation at 21.4 ± 10.2 minutes, did not differ significantly between techniques. CO2 consumption was significantly low for manual morcellation. Visual inspection revealed no bag damage when manual morcellation was performed, but bag damage occurred in 3 dual-site cases and in 1 single-site case. CONCLUSION Considering preventing specimen leakage as the main aim of contained morcellation, the bag used for power morcellation needs improvement. Although manual morcellation requires an umbilical wound of about 25 mm, the absence of bag damage, acceptable total morcellation time, relatively low CO2 consumption, and nonuse of a power device, which translate to an economic benefit, lead us to conclude that manual morcellation will remain advantageous into the future.
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Affiliation(s)
- Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan.
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo Urayasu Hospital (Dr. Kikuchi), Urayasu, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Syuhei Okamoto
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Tsuyoshi Hisa
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Takeru Sugihara
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Rie Kitano
- Department of Obstetrics and Gynecology, Tsuchiura Kyodo General Hospital (Dr. Kitano), Tsuchiura, Japan
| | - Kohei Omatsu
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Terumi Tanigawa
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
| | - Nobuhiro Takeshima
- Department of Gynecologic Oncology, Cancer Institute Hospital (Drs. Aoki, Kanao, Nomura, Okamoto, Hisa, Sugihara, Omatsu, Tanigawa, and Takeshima), Tokyo, Japan
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19
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Benton A, Sood S, Wagner S, Newell J, Harkins G. Disseminated Peritoneal Leiomyomatosis Following Hysteroscopic Leiomyoma Morcellation. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrea Benton
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Shelly Sood
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA
| | - Stephen Wagner
- Departments of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Jordan Newell
- Departments of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Gerald Harkins
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA
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20
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van den Haak L, van der Eijk AC, Sandberg EM, Frank GPGM, Ansink K, Pelger RCM, de Kroon CD, Jansen FW. Towards spill-free in-bag morcellation: a health failure mode and effects analysis. Surg Endosc 2018; 32:4357-4362. [PMID: 29987561 PMCID: PMC6132883 DOI: 10.1007/s00464-018-6284-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/18/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND To assess potential risks of new surgical procedures and devices before their introduction into daily practice, a prospective risk inventory (PRI) is a required step. This study assesses the applicability of the Health Failure Mode and Effects Analysis (HFMEA) as part of a PRI of new technology in minimally invasive gynecologic surgery. METHODS A reference case was defined of a patient with presumed benign leiomyoma undergoing a laparoscopic hysterectomy or myomectomy including in-bag power morcellation; however, pathology defined a stage I uterine leiomyosarcoma. Using in-bag morcellation as a template, a HFMEA was performed. All steps of the in-bag morcellation technique were identified. Next, the possible hazards of these steps were explored and possible measures to control these hazards were discussed. RESULTS Five main steps of the morcellation process were identified. For retrieval bags without openings to accommodate instruments inside the bag, 120 risks were identified. Of these risks, 67 should be eliminated. For containment bags with openings 131 risks were identified of which 68 should be eliminated. Of the 10 causes most at risk to cause spillage, two can be eliminated by using appropriate bag materials. Myomectomy appears to be more at risk for residual tissue spillage compared to total hysterectomy. CONCLUSION The HFMEA has provided important new insights regarding potential weaknesses of the in-bag morcellation technique, particularly with respect to hazardous steps in the morcellation process as well as requirements that bags should meet. As such, this study has shown HFMEA to be a valuable method that identifies and quantifies potential hazards of new technology.
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Affiliation(s)
- Lukas van den Haak
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Anne C van der Eijk
- Central Sterile Supply Department, Leiden University Medica Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Evelien M Sandberg
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Gerard Peter G M Frank
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Karin Ansink
- Operating Room Center, Leiden University Medica Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Cor D de Kroon
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Frank Willem Jansen
- Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Department of BioMechanical Engineering, Delft University of Technology, PO Box 5, 2600 AA, Delft, The Netherlands.
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21
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Single port access laparoscopic subtotal hysterectomy using contained manual morcellation: Experience from a tertiary referral center in Taiwan. Taiwan J Obstet Gynecol 2018; 57:28-31. [PMID: 29458899 DOI: 10.1016/j.tjog.2017.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2017] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To describe the surgical outcomes of single port access laparoscopic subtotal hysterectomy (LSH) using in-bag manual morcellation and evaluate the feasibility of this procedure. MATERIALS AND METHODS Thirty patients with symptomatic leiomyoma or adenomyosis were enrolled. A 2-cm transverse incision was made at the umbilicus and single port apparatus (LagiPort) was applied. After dissection of vesicouterine peritoneum from the uterus, the uterine ligaments and vessels were secured and transected by Gyrus PK cutting forceps. Cervical amputation at the level of internal os was made by SupraLoop (Karl Storz). The uterine corpus was put into an Endobag before morcellation. The opening of Endobag was exteriorized from the umbilical incision and the uterine corpus was removed in a contained manner by manual morcellation with a scalpel. RESULTS This procedure was successfully performed on all patients. Neither laparotomic conversion nor additional port was needed. The mean age and mean BMI of the patients were 43.63 years and 24.02 kg/㎡. The mean operative time was 148 min and the estimated blood loss in most patients was less than 150 ml. The median weight of uterine corpus was 214 g. No intraoperative complications occurred in any patient. One patient was diagnosed with unexpected endometrioid adenocarcinoma FIGO grade 1 postoperatively. One patient reported cyclic bleeding and underwent a transvaginal trachelectomy 17 months later. CONCLUSION Single port access LSH using contained manual morcellation represents a safe and feasible alternative to conventional LSH using open power morcellation.
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Abstract
PURPOSE OF REVIEW This review was written in an effort to describe the evolution of power morcellation equipment from their creation to their current state. In addition, this review addresses the continuously evolving equipment involved with power morcellation and looks to describe where the field is headed in the future. In addition, recent professional and federal recommendations have changed the way power morcellation is being approached and has led to the development of contained morcellation systems, which, although in their infancy, are also being proven to be well tolerated options. RECENT FINDINGS This article will review the most current research on electronic power morcellation and the multiple attempts to prove superiority from the many different types of equipment, and also the many different approaches to morcellation. In addition, with the adaptation to contained morcellation, this review will cover research focused on optimizing a containment system and the techniques involved. SUMMARY In summary, this review is aimed at describing many of the currently available power morcellation products and contained morcellation systems in an effort to allow physicians to understand the different options available, and to discuss well tolerated, effective, and clinically proven techniques that can lead to improved surgical outcomes in the future.
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23
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Manual morcellation compared to power morcellation during robotic myomectomy. J Robot Surg 2018; 13:209-214. [DOI: 10.1007/s11701-018-0837-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/10/2018] [Indexed: 12/16/2022]
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24
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Development and evaluation of an improved laparoscopic myomectomy adopting intracapsular rotary-cut procedures. Eur J Obstet Gynecol Reprod Biol 2018; 221:5-11. [DOI: 10.1016/j.ejogrb.2017.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/02/2017] [Accepted: 11/26/2017] [Indexed: 12/28/2022]
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25
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Shim J, Kenton K, Abernethy MG. Pathology of Power Morcellation: A 12-Year Retrospective Analysis. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2017.0117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jessica Shim
- Department of Obstetrics and Gynecology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Kimberly Kenton
- Female Pelvic Medicine and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Melinda G. Abernethy
- Female Pelvic Medicine and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
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Tanos V, Berry K. Benign and malignant pathology of the uterus. Best Pract Res Clin Obstet Gynaecol 2018; 46:12-30. [DOI: 10.1016/j.bpobgyn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 01/11/2023]
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27
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Tissue Extraction Techniques for Leiomyomas and Uteri During Minimally Invasive Surgery. Obstet Gynecol 2017; 130:1251-1260. [DOI: 10.1097/aog.0000000000002334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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28
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Ciavattini A, Clemente N, Delli Carpini G, Saccardi C, Borgato S, Litta P. Laparoscopic uterine artery bipolar coagulation plus myomectomy vs traditional laparoscopic myomectomy for "large" uterine fibroids: comparison of clinical efficacy. Arch Gynecol Obstet 2017; 296:1167-1173. [PMID: 28956149 DOI: 10.1007/s00404-017-4545-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/19/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Laparoscopic myomectomy is the uterus-preserving surgical approach of choice in case of symptomatic fibroids. However, it can be a difficult procedure even for an experienced surgeon and can result in excessive blood loss, prolonged operating time and postoperative complications. A combined approach with laparoscopic uterine artery occlusion and simultaneous myomectomy was proposed to reduce these complications. The aim of this study was to evaluate the safety and efficacy of the combined laparoscopic approach in women with symptomatic "large" intramural uterine fibroids, compared to the traditional laparoscopic myomectomy alone. METHODS Prospective nonrandomized case-controlled study of women who underwent a conservative surgery for symptomatic "large" (≥ 5 cm in the largest diameter) intramural uterine fibroids. The "study group" consisted of women who underwent the combined approach (laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy), while women who underwent the traditional laparoscopic myomectomy constituted the "control group". A comparison between the two groups was performed, and several intraoperative and postoperative outcomes were evaluated. RESULTS No significant difference in the overall duration of surgery between women of the "study group" and "control group" emerged; however, a significantly shorter surgical time for myomectomy was observed in the "study group". The intraoperative blood loss and the postoperative haemoglobin drop were significantly lower in the "study group". No difference in the postoperative pain between groups emerged, and the postoperative hospital stay was similar in the two groups. CONCLUSIONS The laparoscopic uterine artery bipolar coagulation and simultaneous myomectomy is a safe and effective procedure, even in women with symptomatic "large" intramural uterine fibroids, with the benefit of a significant reduction in the intraoperative blood loss when compared to the traditional laparoscopic myomectomy.
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Affiliation(s)
- Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy.
| | - Nicolò Clemente
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Università Politecnica delle Marche, Via F. Corridoni 11, 60123, Ancona, Italy
| | - Carlo Saccardi
- Department of Woman and Child Health, Università di Padova, Padua, Italy
| | - Shara Borgato
- Department of Woman and Child Health, Università di Padova, Padua, Italy
| | - Pietro Litta
- Department of Woman and Child Health, Università di Padova, Padua, Italy
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Clark NV, Cohen SL. Tissue Extraction Techniques During Laparoscopic Uterine Surgery. J Minim Invasive Gynecol 2017; 25:251-256. [PMID: 28866098 DOI: 10.1016/j.jmig.2017.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 10/18/2022]
Abstract
Morcellation allows minimally invasive approaches to surgery even in the presence of large uteri or myomas. Recent restrictions in the use of power morcellation, as well as concerns regarding the potential for morcellation to disseminate malignant tissue, have initiated investigation and innovation to find safer methods. This review examines current techniques for tissue extraction during uterine surgery, with a focus on contained power morcellation and contained manual morcellation via mini-laparotomy or colpotomy. Videos are included to demonstrate these methods.
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Affiliation(s)
- Nisse V Clark
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah L Cohen
- Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
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Ghezzi F, Casarin J, De Francesco G, Puggina P, Uccella S, Serati M, Cromi A. Transvaginal contained tissue extraction after laparoscopic myomectomy: a cohort study. BJOG 2017; 125:367-373. [PMID: 28467660 DOI: 10.1111/1471-0528.14720] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the technique and report perioperative outcomes of transvaginal contained extraction of surgical specimens at laparoscopic myomectomy. DESIGN Retrospective analysis of prospectively collected data. SETTING Two Italian referral centres for gynaecological minimally invasive surgery. POPULATION Consecutive patients who underwent laparoscopic myomectomy. METHODS Tissue extraction was accomplished following laparoscopic myomectomy in a specimen retrieval bag via a posterior colpotomy incision. If morcellation was necessary, this was performed extracorporeally, using a scalpel within the specimen retrieval pouch, whose edges were exteriorised through the vaginal introitus. MAIN OUTCOME MEASURES Intra- and postoperative complications. RESULTS A total of 316 women underwent transvaginal specimen retrieval with enclosed manual morcellation. The mean myomectomy specimen weight was 154 ± 128 g, and the mean operative time was 79 ± 26 minutes. No intraoperative complications occurred related to the specimen extraction or morcellation technique, or from rupture of the retrieval bag. Two (0.6%) women had a haemoperitoneum that spontaneously resolved and 16 (5.1%) had fever postoperatively. The final pathological diagnosis was benign in all cases. At the 30-day follow-up, no pelvic infection, vaginal dehiscence, or complaints of dyspareunia were recorded. CONCLUSIONS Contained transvaginal extraction of fibroid specimens can be performed safely and efficiently in most women undergoing laparoscopic myomectomy. This technique represents a valuable minimally invasive alternative to intracorporeal morcellation. TWEETABLE ABSTRACT Transvaginal contained morcellation at laparoscopic myomectomy is a valuable alternative to intracorporeal morcellation.
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Affiliation(s)
- F Ghezzi
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - J Casarin
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - G De Francesco
- Department of Obstetrics and Gynaecology, Evangelical Hospital, 'Villa Betania', Naples, Italy
| | - P Puggina
- Department of Obstetrics and Gynaecology, Evangelical Hospital, 'Villa Betania', Naples, Italy
| | - S Uccella
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - M Serati
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - A Cromi
- Department of Obstetrics and Gynaecology, Del Ponte Hospital, University of Insubria, Varese, Italy
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Taylan E, Sahin C, Zeybek B, Akdemir A. Contained Morcellation: Review of Current Methods and Future Directions. Front Surg 2017; 4:15. [PMID: 28352629 PMCID: PMC5348539 DOI: 10.3389/fsurg.2017.00015] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/28/2017] [Indexed: 11/30/2022] Open
Abstract
Power morcellation of surgical specimen during laparoscopic surgery is a practical technology that provides the opportunity to perform several minimally invasive procedures. However, this technology brought forward additional risks and complications associated with dissemination of both benign and malignant tissues inside the abdominal cavity. Based on startling cases, Food and Drug Administration (FDA) announced a discouraging statement on the use of power morcellators that decreased the number of minimally invasive approaches in the following period. As a response to these concerns and negative impacts of the FDA statement, researchers developed several new approaches resulting in contained or in-bag morcellation methods. In this review, we aimed to discuss these current methods and provide an insight for future developments.
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Affiliation(s)
- Enes Taylan
- Laboratory of Molecular Reproduction and Fertility Preservation, Division of Reproductive Medicine, Department of Obstetrics and Gynecology, New York Medical College, New York, NY, USA; Department of Obstetrics and Gynecology, Ege University School of Medicine, Izmir, Turkey
| | - Cagdas Sahin
- Department of Obstetrics and Gynecology, Ege University School of Medicine , Izmir , Turkey
| | - Burak Zeybek
- Department of Obstetrics and Gynecology, University of Texas Medical Branch , Galveston, TX , USA
| | - Ali Akdemir
- Department of Obstetrics and Gynecology, Ege University School of Medicine , Izmir , Turkey
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Cohen A, Tulandi T. Long-term sequelae of unconfined morcellation during laparoscopic gynecological surgery. Maturitas 2017; 97:1-5. [DOI: 10.1016/j.maturitas.2016.11.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 12/12/2022]
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Bean EMR, Cutner A, Holland T, Vashisht A, Jurkovic D, Saridogan E. Laparoscopic Myomectomy: A Single-center Retrospective Review of 514 Patients. J Minim Invasive Gynecol 2017; 24:485-493. [DOI: 10.1016/j.jmig.2017.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 11/26/2022]
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Abstract
BACKGROUND AND OBJECTIVES The well-known advantages of minimally invasive surgery make the approach well suited for hysterectomy and other gynecological procedures. The removal of specimens excised during surgery has been a challenge that has been answered by the use of power morcellation. With this study we sought to assess the feasibility of power morcellation within a specimen bag. METHODS This was a retrospective cohort study including patients from a private practice in suburban Chicago, Illinois, who underwent contained electromechanical power morcellation during a laparoscopic or robot-assisted hysterectomy or myomectomy from May 2014 through December 2015. Contained power morcellation was performed with the Espiner EcoSac 230 (Espiner Medical Ltd., North Somerset, United Kingdom) specimen bag. Descriptive statistics were performed for both categorical and continuous data. RESULTS Of the 187 procedures performed, 73.8% were myomectomies, and 26.2% were hysterectomies. The patients' mean age was 40 (range, 25-54) years and mean body mass index was 28.7 (range, 17.3-57.6). The average specimen weight was 300 g, with the largest weighing 2134 g. Estimated blood loss averaged 98.4 mL. The postoperative admission rate was 12.3%, most of which were due to nausea and urinary retention. Seventeen patients (9.1%) had postoperative complications, most of which were minor, and 4 (2.1%) were readmitted. There were no bag failures or complications that were due to the use of the specimen bag or to power morcellation. CONCLUSIONS Performing electromechanical power morcellation within the Espiner EcoSac 230 specimen bag was successfully performed in 187 patients with no bag-related complications. This method of contained power morcellation is feasible, reliable, and reproducible, even for a large specimen.
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Affiliation(s)
| | - Aarathi Cholkeri-Singh
- Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
| | | | - Charles E Miller
- Minimally Invasive Gynecology, Advocate Lutheran General Hospital, Park Ridge, Illinois, USA
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Gujral H, Vilkins A, Clark NV, Vogell AB, Wright KN. Determining a Learning Curve for Contained Hand Tissue Extraction: Perioperative Outcomes and Operative Time. J Minim Invasive Gynecol 2017; 24:103-107. [DOI: 10.1016/j.jmig.2016.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/19/2016] [Accepted: 09/26/2016] [Indexed: 01/11/2023]
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Arkenbout EA, van den Haak L, Penning M, Rog E, Vierwind A, van Cappelle LE, Jansen FW, de Winter JCF. A Laparoscopic Morcellator Redesign to Constrain Tissue Using Integrated Gripping Teeth. J Med Device 2016. [DOI: 10.1115/1.4034882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Laparoscopic hysterectomy is a procedure that involves the removal of the uterus through an abdominal keyhole incision. Morcellators have been specifically designed for this task, but their use has been discouraged by the food and drug administration (FDA) since November 2014 because of risks of cancerous tissue spread. The use of laparoscopic bags to catch and contain tissue debris has been suggested, but this does not solve the root cause of tissue spread. The fundamental problem lies in the tendency of the tissue mass outside the morcellation tube to rotate along with the cutting blade, causing tissue to be spread through the abdomen. This paper presents a bio-inspired concept that constrains the tissue mass in the advent of its rotation in order to improve the overall morcellation efficacy and reduce tissue spread. A design of gripping teeth integrated into the inner diameter of the morcellation tube is proposed. Various tooth geometries were developed and evaluated through an iterative process in order to maximize the gripping forces of these teeth. The maximum gripping force was determined through the measurement of force–displacement curves during the gripping of gelatin and bovine tissue samples. The results indicate that a tooth ring with a diameter of 15 mm can provide a torque resistance of 1.9 Ncm. Finally, a full morcellation instrument concept design is provided.
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Affiliation(s)
- E. A. Arkenbout
- Biomechanical Engineering Department, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands e-mail:
| | - L. van den Haak
- Department of Gynecology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands e-mail:
| | - M. Penning
- Life Science and Technology Department, Faculty of Applied Sciences, Lorentzweg 1, Delft 2628 CJ, The Netherlands e-mail:
| | - E. Rog
- Maritime Transport Technology Department, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands e-mail:
| | - A. Vierwind
- Life Science and Technology Department, Faculty of Applied Sciences, Lorentzweg 1, Delft 2628 CJ, The Netherlands e-mail:
| | - L. E. van Cappelle
- Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands e-mail:
| | - F. W. Jansen
- Department of Gynecology, Leiden University Medical Center, Albinusdreef 2, Leiden 2333 ZA, The Netherlands e-mail:
| | - J. C. F. de Winter
- Biomechanical Engineering Department, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, Delft 2628 CD, The Netherlands e-mail:
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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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Huang BS, Yang MH, Wang PH, Li HY, Chou TY, Chen YJ. Oestrogen-induced angiogenesis and implantation contribute to the development of parasitic myomas after laparoscopic morcellation. Reprod Biol Endocrinol 2016; 14:64. [PMID: 27716434 PMCID: PMC5053344 DOI: 10.1186/s12958-016-0200-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
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Affiliation(s)
- Ben-Shian Huang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, National Yang-Ming University Hospital, No.169, Siaoshe Road, Yilan, 260 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Muh-Hwa Yang
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Hsin-Yang Li
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
| | - Yi-Jen Chen
- Department of Obstetrics and Gynaecology, Taipei Veterans General Hospital, No.201, Sec. 2, Shih-Pai Road, Taipei, 112 Taiwan
- Department of Obstetrics and Gynaecology, School of Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, No.155, Sec.2, Li-Nong Street, Taipei, 112 Taiwan
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Complex Laparoscopic Myomectomy with Severe Adhesions Performed with Proper Preventive Measures and Power Morcellation Provides a Safe Choice in Certain Infertility Cases. Case Rep Obstet Gynecol 2016; 2016:4705790. [PMID: 27668110 PMCID: PMC5030427 DOI: 10.1155/2016/4705790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 08/04/2016] [Accepted: 08/18/2016] [Indexed: 11/18/2022] Open
Abstract
Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases). We review a 30-year-old female, without previous gestations, hypermenorrhea, intermenstrual bleeding, and chronic pelvic pain. Transvaginal ultrasound reports multiple fibroids in the right portion of a bicornuate uterus. Relevant history includes open myomectomy 6 years before and a complicated appendectomy, developing peritonitis within a year. Laparoscopy revealed multiple adhesions blocking uterine access, a bicornuate uterus, and myomas in the expected site. Myomectomy was performed utilizing power morcellation with good results. FDA recommendations have diminished this procedure's selection, converting many to open variants. This particular case was technically challenging, requiring morcellation, and safety device deployment was impossible, yet the infertility issue was properly addressed. Patient evaluation, safety measures, and laparoscopy benefits may outweigh the risks in particular cases as this one.
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Sandberg EM, van den Haak L, Bosse T, Jansen FW. Disseminated leiomyoma cells can be identified following conventional myomectomy. BJOG 2016; 123:2183-2187. [DOI: 10.1111/1471-0528.14265] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 12/27/2022]
Affiliation(s)
- EM Sandberg
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - L van den Haak
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
| | - T Bosse
- Department of Pathology; Leiden University Medical Centre; Leiden the Netherlands
| | - FW Jansen
- Department of Gynaecology; Leiden University Medical Centre; Leiden the Netherlands
- Department of BioMechanical Engineering; Delft University of Technology; Delft the Netherlands
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Feasibility of Washings at the Time of Laparoscopic Power Morcellation: A Pilot Study. J Minim Invasive Gynecol 2016; 23:793-7. [DOI: 10.1016/j.jmig.2016.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/11/2016] [Accepted: 03/31/2016] [Indexed: 11/22/2022]
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Aoki Y, Matsuura M, Matsuno T, Yamamoto T. Single-site in-bag morcellation achieved via direct puncture of the pneumoperitoneum cap, a cordless electric morcellator, and a 5-mm flexible scope. Eur J Obstet Gynecol Reprod Biol 2016; 201:126-30. [DOI: 10.1016/j.ejogrb.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 12/11/2022]
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Viner AC, Menezes MQ. An Overview of the Aetiology, Epidemiology, Symptomatology and Management of Uterine Fibroids. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0150-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Preclinical safety testing for morcellation and extraction for an endobag with sealable ports: in vitro pilot study. Surg Endosc 2016; 31:494-500. [DOI: 10.1007/s00464-016-4969-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 05/03/2016] [Indexed: 12/14/2022]
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Anapolski M, Panayotopoulos D, Alkatout I, Soltesz S, Mettler L, Schiermeier S, Hatzmann W, Noé G. Power morcellation inside a secure endobag: a pilot study. MINIM INVASIV THER 2016; 25:203-9. [DOI: 10.1080/13645706.2016.1176932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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47
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Sandberg EM, Cohen SL, Jansen FW, Einarsson JI. Analysis of Risk Factors for Intraoperative Conversion of Laparoscopic Myomectomy. J Minim Invasive Gynecol 2016; 23:352-7. [DOI: 10.1016/j.jmig.2015.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/27/2022]
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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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Gao Z, Li L, Meng Y. A Retrospective Analysis of the Impact of Myomectomy on Survival in Uterine Sarcoma. PLoS One 2016; 11:e0148050. [PMID: 26828206 PMCID: PMC4735478 DOI: 10.1371/journal.pone.0148050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/12/2016] [Indexed: 01/10/2023] Open
Abstract
Laparoscopic myomectomy is a minimally invasive, conservative surgical approach commonly used for the treatment of uterine fibroids. However, there is a lack of effective means to distinguish the nature of uterine tumors prior to surgery. The impact of fibroid morcellation during laparoscopic surgery on the dissemination of cancerous uterine fibroids and long-term survival of patients has gained increasing attention. A retrospective cohort study was conducted to analyze the impact of different surgical approaches on recurrence-free survival (RFS) and overall survival (OS) in patients with a postoperative pathological diagnosis of uterine sarcoma at a single medical center. Patients who underwent the first surgery for uterine fibroids (confined to the uterus) and had a postoperative pathological diagnosis of uterine sarcoma were selected in the Chinese PLA General Hospital from January 2005 to January 2014. Based on the use of fibroid morcellation, the subjects were divided into fibroid morcellation (FM) and total hysterectomy (TH, non-morcellation) groups. Follow-up outcomes, including RFS and OS times, were observed. In total, 59 patients were included, with 30 cases in the FM group and 29 cases in the TH group. There were no significant differences in RFS and OS time between the two groups (RFS: P = 0.16, OS: P = 0.09). Multivariate correlation analysis showed that the impact of a higher grade level on RFS and OS was nearly 2-fold the impact of a lower grade level (RFS: P = 0.04, odds ratio (OR) = 1.97; OS: P = 0.03, OR = 2.29). Intraoperative morcellation, postoperative adjuvant therapy, age, tumor size, FIGO stage, and surgical approach were not risk factors affecting RFS and OS. Fibroid morcellation during laparoscopic surgery (including laparoscopic, transvaginal and transabdominal approaches) had no significant impact on RFS and OS time in patients. However, the 5-year RFS and OS rates were both lower in the FM group than in the TH group. Grade level was a significant risk factor for the prognosis of patients with uterine sarcoma.
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Affiliation(s)
- Zhenzhen Gao
- Department of Obstetrics and Gynecology, General Hospital of Armed Police Forces, Beijing, China
| | - Li’an Li
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (LAL); (YGM)
| | - Yuanguang Meng
- Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beijing, China
- * E-mail: (LAL); (YGM)
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van den Haak L, Arkenbout EA, Sandberg EM, Jansen FW. Power Morcellator Features Affecting Tissue Spill in Gynecologic Laparoscopy: An In-Vitro Study. J Minim Invasive Gynecol 2016; 23:107-12. [DOI: 10.1016/j.jmig.2015.09.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/14/2015] [Accepted: 09/16/2015] [Indexed: 12/22/2022]
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