Uterine morcellation: Surgical implications of the use of a containment-bag system.
CANSAGE ePoster Library. SIMON V. 09/27/19; 275240; eP-107
Vanille SIMON
Vanille SIMON
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Abstract
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OBJECTIVE: To report the feasibility and clinical implications of in-bag morcellation in women undergoing laparoscopic hysterectomy. METHODS: We performed a retrospective cohort study and included all women who required uterine morcellation during a laparoscopic hysterectomy in 2017 and 2018 at our university center by three gynecologic laparoscopists. Women with preoperative suspicion of malignancy were excluded. RESULTS: During the two-year study period, uterine morcellation was required in 106 women undergoing a total laparoscopic hysterectomy. Mean uterine weight was 541+/-291 grams (136-1572), with 11/106 uterus being >1000 grams. In-bag morcellation was attempted in 84/106 (79%) and successfully performed in 80/84 (95%). Uncontained morcellation was decided for 22/106 (21%) women, most of whom had a vaginal morcellation. Operative time was on average 40 minutes longer for the in-bag morcellation group (170+/-48 min versus 130+/-43 min, p<.001), which can be partly explained by the higher mean uterine size in this same group, compared to the uncontained morcellation group (580+/-309 grams versus 391+/-122 grams, p=.01). Complications were infrequent (2/106) and occurred in two women of the in-bag morcellation group. No malignant pathology was diagnosed on histopathological analysis. CONCLUSIONS: In-bag morcellation is feasible in a high proportion of women undergoing a laparoscopic hysterectomy, even in cases of very large uterus (greater than1000g) and is associated with an increase in operative time. More powerful analysis will be required to better assess the potential risk of complications and benefits on reducing spreading of malignant tissue associated with in-bag morcellation.
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