A New Contained Collection Bag For Laparoscopic Myomectomy Morcellation

IntroductionLaparoscopic myomectomy(LM)has become a preferred treatment for women with symptomatic myomas and want to preserve their uteri,yet open power morcellation during LM can result in dissemination of benign or occult malignant tumor cells in abdominopelvic cavity.Developing a new contained collection bag for power morcellation is now encouraged by gynecologic surgeons worldwide.MethodsExperiment one was in vitro experiment.From Feb.1st 2017 to Apr.30 th 2017,8 patients underwent transabdominal myomectomy and all the specimens of myoma were collected.Under direct vision,laparoscopic morcellation was completed in a new designed contained collection bag with the help of an assistant.The in vivo study included a single arm test of 20 consecutive women who underwent LM with the new designed contained collection bag for power morcellation from Nov.3rd 2017 to Apr.31 st 2018.The historical control group was 30 women who underwent open power morcellation during LM right from May.1st 2017 to Oct.31 st 2017.And all patients in historical group underwent open power morcellation with full informed consent.All surgeries were performed by the same experienced senior physicians.All the essential information of patients and surgical related data were collected and analyzed.ResultsA total of 8 patients with uterine myoma were collected in the pre-experiment.The pseudo pneumoperitoneum was successfully established and the rate of inflating success was 100%.All the operative field was clear and all the morcellation were successfully conducted.No case of rupture occurred during the process of morcellation.After the main myoma was morcellated,the remaining tissue fragment amount and weight were calculated.The average amount of 8 patients' myoma was 2.00±1.07g(mean±SD).The average morcellation duration was 22.50±6.09min(mean±SD).The remaining tissue fragment amount and weight were 2.88±1.36 and 1.72±0.77 g respectively(mean±SD).In in vivo study,not one case converted to laparotomy due to any reasons and no intestinal,urinary tract vessel or nerve injury in both groups.The uterus size,maximum diameter of uterus and myoma size between two groups was not significantly different(p=0.65,0.71 and 0.31 respectively).Pseudo pneumoperitoneum were established and clear visualization were guaranteed in all 20 cases of the experiment group.The remaining fragment tissue amount(mean±SD)and weight(mean±SD)in collection bag after morcellation of the experiment group were 5.00±1.48 and 3.87±1.31(g).All collection bag were routine examed by normal saline after LM and no leak or lesion were found.Intraperitoneal irrigating fluid before and after morcelllation were collected for cell count and both the amount of before and after were less than 105-106 /L.Postoperative routine pathology of all tissues confirmed to be no malignant tumor.The operation duration of the experiment group was significantly prolonged by 18 mins compared to the historical control group(P=0.00).ConclusionThis new collection bag system for laparoscopic myomectomy morcellation seems to be effective,feasible and safe.