Application Study Of Preventing Tumoral Spread In Laparoscopic Myomectomy

OBJECTIVE:Appling a hard multi-port containment(HMC)system for laparoscopic power morcellation to prevent tumoral spread and to evaluate its safety,validity,and feasibility.METHODS:In the extracorporeal laparoscopic training box,simulating the power morcellating for laparoscopic myomectomy(LM),analyzed and compared system leakage rate and operation time between the HMC system(experimental group,n=30)and soft port containment system(control group,n=30);In the clinical study,analyzed the women who underwent LM between January 2014 and August 2020 in our hospital,retrospectively.The HMC system was used in the study group(n=193)and the control group underwent unprotected LM(n=1753).The demographic data,perioperative data and follow-up data were analyzed and compared.And the growth activity of abdominal exfoliated leiomyoma cells was detected by primary cell culture and immunohistochemistryRESULTS:In the vitro operation,the leakage rate of the HMC system was 0,which was 16.6%in the control group(5/30).The mean operation time,system placement time and power morcellation time of the experimental group were significantly shorter than those of the control group with statistical differences(17.3±1.77 mins vs.24.6±1.74 mins,6.6±1.29 mins vs 9.3±1.01 mins,8.9±.62 mins vs.12.8±1.52 mins,P<.001);In the clinical study,after 1:1 propensity score matching,no significant differences in the baseline characteristics were observed between 193 matched pairs.In the study group,no system leakage was observed.There were no significant differences between the two groups in terms of the complications,mean total operative time(119.9±46.4 mins vs.120.2±44.2 mins,P=.953),median estimated blood loss[50(10-550)mL vs.50(10-500)mL,P=.621],or mean postoperative hospitalization duration 3.8±1.3 days vs.4±1.4 days,P=.442).The median follow-up times were 21 months and 54 months in the study and control groups,there were 1 case and 5 cases of uterine sarcoma accidentally found in the two groups,respectively.There was no peritoneal tissue spread in the study group.However,three(3/5,0.6%)and six(6/1753,0.3%)patients in the control group experienced malignant and benign peritoneal tissue spread,respectively.Primary cell culture and immunohistochemistry demonstrated growth activity of smooth muscle cells in peritoneal exfoliated leiomyoma fragments.CONCLUSION:The HMC system for laparoscopic power morcellation is valid,safe,and feasible for preventing a tumor spread.