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    Product Review: Technologies for laparoscopic contained tissue extraction

     

    Other products that can be useful for mlCTE are surgical wound retractors such as the Alexis O wound retractor/protector, Mobius mini, and the SurgiSleeve. For larger specimens which require a large mini-laparotomy incision (4–5 cm), the rings can be deployed inside the neck of the exteriorized bags to minimize the risk of inadvertently cutting the bag.

    For smaller specimens just marginally too large for an incision, the Schellpfeffer Forceps are a clever means of extracting a contained specimen without morcellation (Figure 3). The Schellpfeffer Forceps. Image courtesy Laparoscopic Technologies Inc. In a manner similar to obstetric forceps, the Schellpfeffer blades are placed around a bagged specimen and the whole contained package is delivered through the incision.

    Summary

    Few innovative techniques have evolved in a purely linear trajectory. Rather, most involve a few steps forward balanced by a few steps back. The most recent controversy involving morcellation should serve as a reminder to surgeons that complacency is the enemy. We must constantly seek to improve our techniques to ensure the best outcomes for our patients. 

     

    References

    1. Nieboer T, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677.

    2. Seidman MA, Oduyebo T, Muto MG, et al. Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS One. 2012;7(11):e50058.

    3. Food and Drug Administration. Quantitative assessment of the prevalence of unsuspected uterine sarcoma in women undergoing treatment of uterine fibroids: summary and key findings. http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM393589.pdf. Accessed July 29, 2014.

    4. Wright J, Tergas A, Burke W, et al. Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation. JAMA. 2014;doi: 10.1001/jama.2014.9005. [Epub ahead of print]

    5. Society of Gynecologic Oncology. SGO position statement: Morcellation. https://www.sgo.org/newsroom/position-statements-2/morcellation/. Accessed July 29, 2014.

    6. Shibley KA. Feasibility of intra-abdominal tissue isolation and extraction, within an artificially created pneumoperitoneum, at laparoscopy for gynecologic procedures. In: Proceedings from the American Association of Laparoscopic Gynecologists; November 5–9, 2012; Las Vegas, Nevada.

    7. Cook Medical. LapSac. https://www.cookmedical.com/data/IFU_PDF/T_LPSC_REV1.PDF. Accessed August 6, 2014.

     

    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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