Safety and efficacy of contained manual morcellation during laparoscopic or robotic gynecological surgery.

Abstract

To assess the safety and efficacy of contained manual morcellation (CMM) with a tissue pouch during minimally invasive robotic or laparoscopic surgeries. A retrospective cohort study included women who underwent robotic or laparoendoscopic single-site surgery at a tertiary referral center between February 2014 and April 2017. The specimen was postoperatively contained, sliced into one or more long strips, and then pulled out. The surgical type, specimen containment time, containment failure rate, specimen weight, manual morcellation time, and overall CMM speed (g/min) were recorded. Surgical complications related (bowel or bladder injury, ureteral injury, vascular injuries, and tumor dissemination) or not related (delayed wound healing, infection, and hernia) to CMM were also documented. The patients were followed up for 2years. A total of 165 cases were recorded, comprising 149 cases that underwent laparoscopic and 16 that underwent robotic gynecological surgeries. The average time for specimen containment and manual morcellation in CMM was 6.7±5.0 and 13.2±11.2min, respectively. The mean morcellation speed was 25.1±8.5g/min. Among the specimens, those of the uterus with adenomyosis had the lowest CMM speed (21.4±8.0g/min), whereas those of the uterus with myoma had the highest speed (27.5±8.9g/min). The pouch perforation rate after CMM was 13.3% and no pouch-related complication was noted. CMM is an efficient method for specimen removal.