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Contained Morcellation for Laparoscopic Myomectomy Within a Specially Designed Bag
Accepted Manuscript Contained morcellation for laparoscopic myomectomy within a specially designed bag Vincent Y.T. Cheung, MBBS, FRCOG, FRCSC, T.C. Pun, MBBS, FRCOG
PII:
S1553-4650(15)01547-2
DOI:
10.1016/j.jmig.2015.08.889
Reference:
JMIG 2678
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 26 August 2015 Accepted Date: 27 August 2015
Please cite this article as: Cheung VYT, Pun TC, Contained morcellation for laparoscopic myomectomy within a specially designed bag, The Journal of Minimally Invasive Gynecology (2015), doi: 10.1016/ j.jmig.2015.08.889. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Contained morcellation for laparoscopic myomectomy
RI PT
within a specially designed bag
Vincent Y.T. Cheung, MBBS, FRCOG, FRCSC
SC
T.C. Pun, MBBS, FRCOG?)
M AN U
Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Corresponding author: Vincent Y.T. Cheung
Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong E-mail: [email protected] Telephone: 852-22553914 Facsimile: 852-25173278
AC C
EP
TE D
Address:
ACCEPTED MANUSCRIPT
We read with interest the recently published article by Paul et al [1], which reported a case series of 10 patients who underwent contained power morcellation of myomas within a specially designed bag. We support the use of this technique for laparoscopic retrieval of myomas as we have been using this technique since June 2015. However, we use a different tissue retrieval bag -- the EcoSac (Espiner Medical Limited, North Somersert, United Kingdom, Fig. 1). We believe that sharing of our experience will help
RI PT
refine the technique and design a future retrieval bag system specifically for the purpose of contained power morcellation, with an ultimate aim to improve patient safety. Also, this will give gynecologists an alternative choice of retrieval bags when considering contained
SC
morcellation.
EcoSac bags come in different sizes, but we use the larger ones in their series, mostly the EMP 180 ECO (volume 2000 ml, Fig. 1). Similar to the technique described by
M AN U
Paul et al [1], the bag is deployed into the peritoneal cavity through the 12 mm suprapubic port. After the specimen is placed inside the bag, the wide opening (Fig. 1, large arrows) is pulled out of the 12 mm port. Under laparoscopic guidance, the tail end of the bag (Fig. 1) is pull out through the 10 mm umbilical port, where a hole is made with a pair of scissors and a 6 mm trocar sheath is introduced; through which the bag is insufflated and a 5 mm
TE D
laparoscope is introduced for direct visualization of the morcellation process, with the 10 mm electric morcellator inserted through the suprapubic port. Although this bag is not designed specifically for contained power morcellation, it has been working well for us for this purpose; and additionally, by pushing the bowel out of the way using the insufflated
EP
bag, it seems to be a much safer process than traditional non-contained morcellation.
AC C
EcoSacs are made from very strong ripstop nylon which is difficult to break manually [2]. Any accidental cut made in the material will not extend, thus reduce the likelihood of leakage during specimen retrieval [2]. Clearly this bag has limitations. It does not conform the shape of the peritoneal cavity and the intended port sites. It is claimed to be radiopaque by the manufacturer [2]. However, when we put the bag through X-ray, it was only true for the small piece of metal at the end of the drawstring and the tail loop (Fig. 1). The bag itself was radiolucent, thus X-ray would not help when trying to locate missing nylon pieces, albeit a supposingly rare occurrence. These are issues to consider when developers like Dr. Paul are designing newer bags dedicated for contained power morcellation.
ACCEPTED MANUSCRIPT
Declaration
The authors declare no conflict of interest particularly financial interest of any form with Espiner Medical Limited.
References
2.
www.espinermedical.com. Accessed August 25, 2015.
SC
Figure Legends
RI PT
1. Paul PG, Thomas M, Das T, Patil S, Garg R. Contained morcellation for laparoscopic myomectomy within a specially designed bag. J Minim Invasive Gynecol. 2015 Aug 7. pii: S1553-4650(15)00611-1.
AC C
EP
TE D
M AN U
Fig. 1. The Ecosac retrieval bag. The wide opening (large arrows) and the tail end (T) are shown as indicated. Only the small metal piece at the end of the drawstring (M) and the tail loop (T) are radiopaque.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
PII:
S1553-4650(15)01547-2
DOI:
10.1016/j.jmig.2015.08.889
Reference:
JMIG 2678
To appear in:
The Journal of Minimally Invasive Gynecology
Received Date: 26 August 2015 Accepted Date: 27 August 2015
Please cite this article as: Cheung VYT, Pun TC, Contained morcellation for laparoscopic myomectomy within a specially designed bag, The Journal of Minimally Invasive Gynecology (2015), doi: 10.1016/ j.jmig.2015.08.889. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Contained morcellation for laparoscopic myomectomy
RI PT
within a specially designed bag
Vincent Y.T. Cheung, MBBS, FRCOG, FRCSC
SC
T.C. Pun, MBBS, FRCOG?)
M AN U
Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
Corresponding author: Vincent Y.T. Cheung
Department of Obstetrics and Gynaecology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong E-mail: [email protected] Telephone: 852-22553914 Facsimile: 852-25173278
AC C
EP
TE D
Address:
ACCEPTED MANUSCRIPT
We read with interest the recently published article by Paul et al [1], which reported a case series of 10 patients who underwent contained power morcellation of myomas within a specially designed bag. We support the use of this technique for laparoscopic retrieval of myomas as we have been using this technique since June 2015. However, we use a different tissue retrieval bag -- the EcoSac (Espiner Medical Limited, North Somersert, United Kingdom, Fig. 1). We believe that sharing of our experience will help
RI PT
refine the technique and design a future retrieval bag system specifically for the purpose of contained power morcellation, with an ultimate aim to improve patient safety. Also, this will give gynecologists an alternative choice of retrieval bags when considering contained
SC
morcellation.
EcoSac bags come in different sizes, but we use the larger ones in their series, mostly the EMP 180 ECO (volume 2000 ml, Fig. 1). Similar to the technique described by
M AN U
Paul et al [1], the bag is deployed into the peritoneal cavity through the 12 mm suprapubic port. After the specimen is placed inside the bag, the wide opening (Fig. 1, large arrows) is pulled out of the 12 mm port. Under laparoscopic guidance, the tail end of the bag (Fig. 1) is pull out through the 10 mm umbilical port, where a hole is made with a pair of scissors and a 6 mm trocar sheath is introduced; through which the bag is insufflated and a 5 mm
TE D
laparoscope is introduced for direct visualization of the morcellation process, with the 10 mm electric morcellator inserted through the suprapubic port. Although this bag is not designed specifically for contained power morcellation, it has been working well for us for this purpose; and additionally, by pushing the bowel out of the way using the insufflated
EP
bag, it seems to be a much safer process than traditional non-contained morcellation.
AC C
EcoSacs are made from very strong ripstop nylon which is difficult to break manually [2]. Any accidental cut made in the material will not extend, thus reduce the likelihood of leakage during specimen retrieval [2]. Clearly this bag has limitations. It does not conform the shape of the peritoneal cavity and the intended port sites. It is claimed to be radiopaque by the manufacturer [2]. However, when we put the bag through X-ray, it was only true for the small piece of metal at the end of the drawstring and the tail loop (Fig. 1). The bag itself was radiolucent, thus X-ray would not help when trying to locate missing nylon pieces, albeit a supposingly rare occurrence. These are issues to consider when developers like Dr. Paul are designing newer bags dedicated for contained power morcellation.
ACCEPTED MANUSCRIPT
Declaration
The authors declare no conflict of interest particularly financial interest of any form with Espiner Medical Limited.
References
2.
www.espinermedical.com. Accessed August 25, 2015.
SC
Figure Legends
RI PT
1. Paul PG, Thomas M, Das T, Patil S, Garg R. Contained morcellation for laparoscopic myomectomy within a specially designed bag. J Minim Invasive Gynecol. 2015 Aug 7. pii: S1553-4650(15)00611-1.
AC C
EP
TE D
M AN U
Fig. 1. The Ecosac retrieval bag. The wide opening (large arrows) and the tail end (T) are shown as indicated. Only the small metal piece at the end of the drawstring (M) and the tail loop (T) are radiopaque.
AC C
EP
TE D
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT