Methods for specimen removal from the peritoneal cavity after laparoscopic excision

Abstract

In the age of specialisation, a clinician who is not specially trained in operative laparoscopic surgery should not be practicing it. To minimise complications, the excision and retrieval of specimens via minimally invasive incisions should be limited to specially trained individuals.

The Use of Ovarian Wall as an Endobag During Laparoscopic Removal of a Giant Dermoid Cyst: A New Approach

“…Laparoscopy is the standard treatment for excision of benign ovarian cysts and provides many advantages over laparotomy (4)(5)(6)(7)(8)(9)(10)(11)(12). Though laparoscopic surgery is associated with a longer operating time compared to laparotomy, the advantages are: less postoperative pain, reduced postoperative analgesic need, earlier mobilization which reduces chances of deep venous thrombosis, short hospital stay, reduced infectious morbidity, earlier recovery, better quality of life with early return to normal activity during the postoperative period and acceptable mini incisions (3)(4)(5)(8)(9)(10)(11)(12)(13)(14)(15)(16). Because most patients with benign cystic teratomas belong to the reproductive age, a minimally invasive approach is ideal, as it minimizes the risk of adhesions and its effects.…”

“…Laparoscopic management of large ovarian masses, however, is still under debate (5,10,16,18). Conventionally, these huge masses were dealt with by open laparotomy (8)(9)(10)(11)13). There is increasing evidence that the vast majority of large adnexal masses can be resected laparoscopically (12,14,(16)(17)(18)(19)(20).…”

“…The major determinants deciding the mode of surgery, whether by a traditional open laparotomy or by laparoscopy, are the nature of the mass, the operator experience and patient preference (1,5). Technical difficulties in tackling such giant cysts, laparoscopically, include: difficulty in inserting the Veress needle/trocar, resulting in cyst puncture and spillage, and the technical challenge of a large specimen retrieval with minimal spillage through a mini incision (10,13).…”

“…Some studies have found no relation between the two (4,10, 13), while others quote a higher probability of spillage with increasing cyst size (3,5,13). Laparoscopic removal of dermoid cysts reports spillage rates ranging from 15%-100%, compared with 4%-13% via laparotomy (3,4,13). Some have found that spillage rates are comparable in laparoscopy and laparotomy (15).…”

Re: Laparoscopic morcellation: an acceptable risk or an Achilles heel? Are there safer alternatives to morcellation?

“…Operative laparoscopy in Gynaecology has advanced tremendously in the last 20 years and more procedures can now be performed safely through three or four small incisions in the abdomen, with substantial postoperative benefits for the patient and the hospital . However, removal of specimens following laparoscopic excision, whether these be large uteruses, fibroids or dermoid cysts, remains a challenge …”