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    Product Review: Technologies for laparoscopic contained tissue extraction

     

    Trocars

    With a multiport iCTE technique, a lateral puncture into the bag is necessary to provide a port for visualization and insufflation. Any standard 5-mm trocar can be used, but the Kii advanced fixation (balloon) shielded bladed trocar in the 5 x 150-mm configuration is ideal for this application (Figure 2). The 5mm Kii Advanced Fixation Trocar. Image courtesy Applied Medical.The balloon at the end minimizes the risk of spillage and helps pull the walls of the bag closer to the abdominal wall. The shielded bladed tip facilitates penetrating the bag—even a rip-stop nylon bag. The added length of the 150-mm configuration allows for more flexibility in accessing the bag’s interior when using smaller bags or more lateral ports.

    Minilaparotomy contained tissue extraction

    As compared with the Shibley-style iCTE, the steps involved with minilaparotomy contained tissue extraction (mlCTE) are identical except that there is no insufflation of the bags and manual morcellation is employed rather than power morcellation. (Power morcellators should never be used when the tip of the morcellator blade cannot be fully visualized.)

    After the specimen is placed into the bag, the neck of the bag is exteriorized and the tissue within the bag is morcellated into smaller pieces with either a knife or scissors and extracted. This technique may be somewhat easier for some surgeons to quickly adopt, but morcellating the tissue without cutting the walls of the bag can be challenging—especially through small incisions.

    Technology to facilitate mlCTE

    As with iCTE, the choice of bag is important. With mlCTE, however, smaller bags can be used because insufflation is not involved. Surgeons’ options include a myriad of traditional plunger-style deployable endoscopic tissue removal bags manufactured from either PVC or rip-stop nylon, although these bags do not exceed 1850 cc in capacity.

    Many companies make PVC plunger-style deployable endoscopic tissue removal bags. In rip-stop nylon, the most popular plunger-style deployable endoscopic tissue removal bags are produced by Anchor Surgical in their Tissue Removal System. Importantly, the seams on these bags are RF-welded rather than stitched, making them less likely to leak than non-coated, stitched rip-stop nylon bags.

     

    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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