Measures to improve the safety of power morcellation in laparoscopic surgery: IMELDA technique

Abstract

The objective of this study was to explore measures to improve the safety of power morcellation in laparoscopic surgery. In this study of 50 patients, the IMELDA technique for specimen morcellation is presented. This is the first in-bag morcellation study to demonstrate cytologically, and with postoperative blue dye tests, that no intraperitoneal spilling occurs using this morcellation technique. IMELDA stands for inked margins in-bag morcellation extracorporeally ligated for dual port access. IMELDA morcellation enables surgeons to change from intraperitoneal power morcellation to contained bag power morcellation, without making larger incisions, and without changes in port placement and visualization angles. Inked margins enable the pathologist to determine where the section margins were in case of an unexpected malignant or premalignant lesion, even though the specimen is morcellated. IMELDA morcellation uses a selfconstruction technique avoiding the need for expensive commercially available in-bag morcellation kits, for which there still is no scientific proof that they are spill proof. Most standard specimen extraction bags can be used to self-construct an IMELDA bag. The port placement can be adjusted to the surgeon's habits and any available morcellator can be used. For very low resource settings, a surgical glove can be used to construct an endobag for this frugally innovative morcellation technique.