In-Bag Morcellation

Risk of Leakage and Tissue Dissemination With Various Contained Tissue Extraction (CTE) Techniques: An in Vitro Pilot Study

“…Alternatives for retrieval of uterine specimens during minimally invasive surgery include colpotomy, minilaparotomy, or contained morcellation within a specimen bag. Early experience with use of in-bag morcellation within a contained pneumoperitoneum has been favorable, and the risk of tissue spread is thought to be minimized with these techniques [14].…”

A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy

“…Several approaches have been described in gynecology to date using different ways of bag insertion, morcellation and tissue extraction. These include abdominal port site [44][45][46][47][48][49] or transvaginal [50] insertion of the bag, open abdominal (mini-laparotomic) [49] or vaginal in-bag morcellation [51][52][53][54][55], each manually under direct vision, and laparoscopic power morcellation within a pseudo-pneumoperitoneum in the bag inside the abdomen [44][45][46][47][48][49][50]. The latter technique provides the possibility of containing morcellation, when vaginal access is not suitable.…”

“…Multiport approach requires at least one puncture of the intraperitoneally insufflated bag in all so far published systems [44][45][46][47][48][49][50]. Puncturing the bag, however, carries the risk of leakage and spilling, and thus opposes the intent of contained morcellation [21,23,25,26,56].…”

“…Systems requiring bag puncture achieve to prevent spilling from the puncture hole by using a balloon tip trocar [44][45][46][47][48][49][50]. Our system provides at this point an intact closed, contained environment for subsequent morcellation.…”

A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature

“…There are reports of power morcellation within an endoscopic bag 68,69 ; however, current endoscopic bags were neither designed for this purpose nor sufficiently studied for this purpose. Notably, there are also mechanical morcellators without the rotational mechanism, which likely would reduce the intraperitoneal dissemination of tumor.…”