Use of contained power morcellation shows promise

A small four-institution study shows promise for use of an insufflated isolation bag as a way of reducing risks of power morcellation while retaining the benefits of minimally invasive surgery. The authors caution, however, that their results are observational and represent outcomes in the hands of high-volume surgeons.

Seventy-three surgeries, performed at Fairview Ridges Hospital (Burnsville, Minnesota), Johns Hopkins Hospital (Baltimore, Maryland), Massachusetts General Hospital (Boston), and Brigham and Women’s Hospital (Boston), are described in the report published in Obstetrics & Gynecology. Performed between January 2013 and April 2014, all the procedures were successful, with no complications and no evidence of tissue dissemination outside the isolation bag.

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Procedures performed included multiport laparoscopy, single-site laparoscopy, multiport robotic-assisted laparoscopy, and single-site robot-assisted laparoscopy. Data collection for all but those procedures done at Fairview Ridges Hospital was prospective. All the surgeries were on women for whom morcellation was planned at the time of minimally invasive myomectomy or hysterectomy. Bags were visually inspected at the end of surgery for perforations other than the 5-mm puncture necessary during the multiport procedure.

Median patient age was 43 (range 30 to 56 years) and median body mass index was 27.9 (range 16.5–56). Preoperative workup included a recent Pap test, endometrial sampling in women with abnormal bleeding, and imaging with pelvic ultrasonography or magnetic resonance imaging.

Median operative time was 114 minutes (range 32–380 minutes) and median estimated blood loss 50 mL (range 10–500 mL). Median specimen weight was 257 g (range 53–1481 g). None of the procedures was converted to laparotomy or involved readmission or reoperation.

“A study of bag integrity after contained morcellation is an important next step,” the authors concluded. They also underscored that, “The intent is not to perform surgery on a malignancy in this manner, but to help protect women who unknowingly have cancer at the time of surgery for presumed benign disease.” 

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