8724 Routes of Specimen Extraction in Laparoscopic Surgery

Abstract

<h3>Study Objective</h3> To demonstrate the operative techniques of three entry methods for in-bag, extracorporeal specimen morcellation including vaginal approach, umbilical mini-laparotomy and suprapubic mini-laparotomy. <h3>Design</h3> We present a surgical video with narration which demonstrates three entry techniques for specimen morcellation. <h3>Setting</h3> Morcellation is a surgical technique which has been used for decades to allow removal of the uterus through the vagina or smaller abdominal incisions². Electromechanical morcellation gained popularity in the early 1990s due its ease of use and efficiency, however concern for the spread of cancer cells in cases of uterine sarcomas led to the practice of manual morcellation using containment bags¹. The American College of Obstetricians and Gynecologists continues to endorse a minimally invasive approach to hysterectomy when possible if the specimen is too large to be removed intact or removing the uterus intact through an abdominal incision². <h3>Patients or Participants</h3> Patients undergoing laparoscopic hysterectomy. <h3>Interventions</h3> We demonstrate three entry routes for manual uterine morcellation: vaginally following colpotomy, umbilical mini-laparotomy and suprapubic mini-laparotomy. <h3>Measurements and Main Results</h3> Specimen extraction via minimally invasive routes. <h3>Conclusion</h3> Vaginal entry following colpotomy, umbilical mini-laparotomy and suprapubic mini-laparotomy are three safe, effective entry methods for the morcellation of large, fibroid uteri which offers a minimally invasive approach for the removal of uterine specimens following laparoscopic hysterectomy.