WA Gynaescope technique a safer method for doing in-bag morcellation during laparoscopic surgery
It appears that the WA Gynaescope technique of in-bag morcellation (IBM) is safe, reproducible and a valuable addition to current methods of specimen retrieval during minimal invasive surgery, according to a study presented at the 2018 World Congress of the Royal College of Obstetricians and Gynaecologists (RCOG 2018) held recently in Singapore.
“It maintains patient safety by allowing direct visualization of surrounding structures while keeping the blades away from the viscera and without the need of additional ports extension,” researchers explained. “The spillage or dissemination of content of surgical specimen is prevented by performing power morcellation in specimen retrieval bag (SRB).”
Of the 155 patients who underwent laparoscopic IBM, no one reported immediate or late complications. There were also no cases of specimen dissemination or visceral injury caused by power morcellation. Furthermore, none of the procedure correlated with SRB failure. [RCOG 2018, abstract 6374]
A single case of leiomyosarcoma was diagnosed on histopathology, which was unsuspected preoperatively. Further staging surgery for the same patient in a tertiary institute did not reveal any evidence of tissue dissemination or staging advancement.
“There has been a significant decrease in the use of power morcellation in minimally invasive hysterectomies and myomectomies after the FDA [Food and Drug Administration] issued a warning in 2014 due to its potential for dissemination of unsuspected uterine malignancy,” researchers said.
Analysis by the FDA revealed that the prevalence of unsuspected uterine sarcoma was one in 352 patients undergoing hysterectomy or myomectomy for presumed benign leiomyoma, and the prevalence of unsuspected uterine leiomyosarcoma was one in 498 patients.
“Due to this, there is a need to investigate a safer method of doing power morcellation. Various types of IBM have been described in different studies. WA Gynaescope technique of IBM is our technique for performing power morcellation while maintaining safety and preventing spillage intraoperatively,” researchers noted.
In this 2-year (September 2015 to September 2017) retrospective study, patients from WA Gynaescope at Joondalup Health Campus in Australia underwent IBM during multiport laparoscopic total/subtotal hysterectomy or myomectomy.
The SRB (15-mm Endocatch 2 Autosure, Covidien) was inserted through the 15-mm suprapubic port site, and its edges were exteriorized to the abdominal wall following specimen retrieval. The port was then introduced in the SRB and the edges were secured around it. CO2 was insufflated into the SRB, and power morcellator was then used through this port. The right side lateral balloon port was deflated and inserted to the bag under direct vision through the umbilical port, followed by balloon inflation in the SRB to prevent any leakage.
IBM was subsequently performed within the SRB with power morcellator under direct vision through the right lateral port, and the remaining contents were then suctioned out. After deflating, the right lateral port was removed from the SRB, which was then removed under direct vision while maintaining intra-abdominal pressure to 15 mm Hg to prevent spillage. The SRB was inspected to avoid perforations apart from those used for balloon port.