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A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures.

Material and methods

The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies.

Results

The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64–21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256).

Conclusion

Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.

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Acknowledgments

The authors thank Reinhold Zimmermann, Esra Foditsch, Ioan Hutu, Irina Patras, Bogdan Hoinoiu and Romana Korlat for their invaluable help during conception, realization and analysis of the described experiments.

Conflict of interest

The present study was financially supported by A.M.I., Feldkirch, Austria. We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Kantonsspital Münsterlingen, Spitalcampus 1, Postfach 100, CH-8596, Münsterlingen, Switzerland

    Stefan Rimbach

  2. Department of Obstetrics and Gynecology, Landeskrankenhaus Feldkirch, Carinagasse 47, 6800, Feldkirch, Austria

    Annette Holzknecht

  3. Institute of Pathology, Landeskrankenhaus Feldkirch, Feldkirch, Austria

    Constanze Nemes & Felix Offner

  4. Department of Obstetrics and Gynecology, University of Timisoara, Timisoara, Romania

    Marius Craina

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  1. Stefan Rimbach
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  4. Felix Offner
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Correspondence to Stefan Rimbach.

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Rimbach, S., Holzknecht, A., Nemes, C. et al. A new in-bag system to reduce the risk of tissue morcellation: development and experimental evaluation during laparoscopic hysterectomy. Arch Gynecol Obstet 292, 1311–1320 (2015). https://doi.org/10.1007/s00404-015-3788-9

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