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    Product Review: Technologies for laparoscopic contained tissue extraction

     

    Technologies to facilitate iCTE

    Containment bags

    At the core of all the variations of iCTE is the extraction bag. In his original description of his technique, Shibley reported using a Lahey bag.

    Lahey bags

    Lahey bags or “isolation bags” are large, sterile, transparent PVC bags initially designed to cover limbs during sterile surgical procedures. These bags are produced by several manufacturers (eg, 3M Steri-Drape Isolation bag 1003, the Iso/Drape Isolation bag). Typically they measure about 50 x 50 cm with a drawstring at the neck. Although the Lahey bag can accommodate virtually any size specimen, it can be unwieldy within the confines of the closed abdomen. Also the material is not overly robust and can easily tear if pulled too hard with laparoscopic instruments—especially during the process of introducing the bag into the abdomen.

    Rip-stop nylon

    Given the limited strength of the Lahey bags and the ease with which they can tear with manipulation, many surgeons have turned to rip-stop nylon bags. However, not all rip-stop nylon products are the same. Because the manufacturing of these products requires stitching or welding of sheets of material, the seams are further treated (usually with polyurethane) to prevent leakage when they are subjected to the higher pressure of insufflation. Given these parameters, 2 products are often used: the LapSac and the Eco Sac.

    LapSac – Cook Medical’s LapSac is the only specimen retrieval product on the market today that carries an FDA-approved indication for tissue morcellation.7 Manufactured from 2 sheets of rip-stop nylon with polyurethane coating over the seams and a drawstring at the neck, the LapSac comes in several sizes, the largest measuring 8 x 10 cm (1500 mL). Although the LapSac performs admirably with smaller specimens and when used to manually morcellate tissue through a mini-laparotomy, its small size makes it of limited use for iCTE.

    Eco Sac – Like the LapSac, the Eco Sac (Figure 1) is constructed from stitched rip-stop nylon coated with polyurethane, but it has several features that make it easier to use with iCTE techniques. The EcoSac 230. Image courtesy Espiner Medical Ltd.First, it comes in much larger sizes, with the largest Eco Sac 230 accommodating 3100 cc. While the larger size increases the amount of material taking up visual space within the limited confines of the pelvis, when insufflated, the 3100-cc bag is perfect for most procedures. Second, the EcoSac has 4 loops secured to the edges that make introducing and manipulating the bag much easier.

     

     

     

    James Greenberg, MD
    Dr. Greenberg is Chief, Division of Gynecology, Brigham & Women’s Faulkner Hospital, and Associate Professor, Harvard Medical School, ...
    Mobolaji Oluwaseun Ajao, MD
    Dr. Ajao is a Fellow in Minimally Invasive Gynecologic Surgery, Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts.

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