Comparison of perioperative surgical outcomes between contained and free manual vaginal morcellation of large uteruses following total laparoscopic hysterectomy.
benign gynecologic pathology
hysterectomy
large uteruses
minimally invasive surgery
morcellation
operative times
perioperative outcomes
retrieval bag
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
08 Nov 2023
08 Nov 2023
Historique:
revised:
10
10
2023
received:
18
06
2023
accepted:
17
10
2023
medline:
8
11
2023
pubmed:
8
11
2023
entrez:
8
11
2023
Statut:
aheadofprint
Résumé
To compare contained and free manual vaginal morcellation of large uteruses after total laparoscopic hysterectomy (TLH) in women at low risk of uterine malignancy in terms of feasibility and safety. A single-center, observational, retrospective, cohort study was carried out including all patients undergoing TLH requiring manual vaginal morcellation for specimen extraction of large uteruses from January 2015 to August 2021 at the Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy. Patients were divided into two groups according to the type of manual vaginal morcellation (contained or free), and compared in terms of demographic, clinical, and perioperative data. In all, 271 patients were included: 186 (68.6%) in the contained morcellation group and 85 (31.4%) in the free morcellation group. The mean operative time was significantly lower in the contained morcellation group compared with the free morcellation group (median [interquartile range] 130 [45] vs. 155 [60] min; P < 0.001). No significant difference was found in complications related to the morcellation step, overall, intraoperative and postoperative complications, estimated blood loss, length of hospital stays, uterine weight, and rate of occult malignancy between the two groups. Contained vaginal manual morcellation of the uterus after total laparoscopic hysterectomy using a specimen retrieval bag appears to be a safe procedure with significantly lower operative time than free vaginal manual morcellation.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
Références
Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;2015:CD003677. doi:10.1002/14651858.CD003677.pub5
Wang H, Li P, Li X, et al. Total laparoscopic hysterectomy in patients with large uteri: comparison of uterine removal by transvaginal and uterine morcellation approaches. Biomed Res Int. 2016;2016:1-8. doi:10.1155/2016/8784601
Alperin M, Kivnick S, Yee Trudy Poon K. Outpatient laparoscopic hysterectomy for large uteri. J Minim Invasive Gynecol. 2012;19:689-694. doi:10.1016/j.jmig.2012.06.007
Kondo W, Tessmann M, Charles L, Bourdel N, Mage G, Canis M. Total Laparoscopic Hysterectomy: Surgical Technique and Results. Advanced Gynecologic Endoscopy. InTech; 2011. doi:10.5772/20224
Payne TN. Robotically assisted hysterectomy in patients with large uteri: outcomes in five community practices. Obstet Gynecol. 2010;116:442. doi:10.1097/AOG.0b013e3181eafc1b
Serur E, Lakhi N. Laparoscopic hysterectomy with manual morcellation of the uterus: an original technique that permits the safe and quick removal of a large uterus. Am J Obstet Gynecol. 2011;204:566.e1-566.e2. doi:10.1016/j.ajog.2011.03.042
Sepilian V, Della Badia C. Iatrogenic endometriosis caused by uterine morcellation during a supracervical hysterectomy. Obstet Gynecol. 2003;102:1125-1127. doi:10.1016/S0029-7844(03)00683-5
Cucinella G, Granese R, Calagna G, Somigliana E, Perino A. Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril. 2011;96:e90-e96. doi:10.1016/j.fertnstert.2011.05.095
Worldwide AA. AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol. 2014;21:517-530. doi:10.1016/j.jmig.2014.05.010
Günthert AR, Christmann C, Kostov P, Mueller MD. Safe vaginal uterine morcellation following total laparoscopic hysterectomy. Am J Obstet Gynecol. 2015;212:546.e1-546.e4. doi:10.1016/j.ajog.2014.11.020
Serur E, Zambrano N, Brown K, Clemetson E, Lakhi N. Extracorporeal manual morcellation of very large uteri within an enclosed endoscopic bag: our 5-year experience. J Minim Invasive Gynecol. 2016;23:903-908. doi:10.1016/j.jmig.2016.03.016
Balgobin S, Maldonado PA, Chin K, Schaffer JI, Hamid CA. Safety of manual morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol. 2016;23:542-547. doi:10.1016/j.jmig.2016.01.014
Cohen SL, Clark NV, Ajao MO, et al. Prospective evaluation of manual morcellation techniques: minilaparotomy versus vaginal approach. J Minim Invasive Gynecol. 2019;26:702-708. doi:10.1016/j.jmig.2018.07.020
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495-1499. doi:10.1016/j.ijsu.2014.07.013
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) group. Ultrasound Obstet Gynecol. 2000;16:500-505. doi:10.1046/j.1469-0705.2000.00287.x
Leone FPG, Timmerman D, Bourne T, et al. Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound Obstet Gynecol. 2010;35:103-112. doi:10.1002/uog.7487
Raffone A, Raimondo D, Neola D, et al. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: a systematic review and meta-analysis. Int J Gynecol Obstet. 2023. doi:10.1002/ijgo.15136
Raffone A, Raimondo D, Neola D, et al. Prevalence of sonographic signs in women with uterine sarcoma: a systematic review and meta-analysis. Ultraschall in Der Medizin - Eur J Ultrasound. 2023. doi:10.1055/a-2151-9205
Rha SE, Byun JY, Jung SE, et al. CT and MRI of uterine sarcomas and their mimickers. Am J Roentgenol. 2003;181:1369-1374. doi:10.2214/ajr.181.5.1811369
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-196. doi:10.1097/SLA.0b013e3181b13ca2
Solima E, Scagnelli G, Austoni V, et al. Vaginal uterine morcellation within a specimen containment system: a study of bag integrity. J Minim Invasive Gynecol. 2015;22:1244-1246. doi:10.1016/j.jmig.2015.07.007
Jones B, Jarvis P, Lewis JA, Ebbutt AF. Trials to assess equivalence: the importance of rigorous methods. BMJ. 1996;313:36-39. doi:10.1136/bmj.313.7048.36
Meurs EAIM, Brito LG, Ajao MO, et al. Comparison of morcellation techniques at the time of laparoscopic hysterectomy and myomectomy. J Minim Invasive Gynecol. 2017;24:843-849. doi:10.1016/j.jmig.2017.04.023
Gitelis M, Vigneswaran Y, Ujiki MB, et al. Educating surgeons on intraoperative disposable supply costs during laparoscopic cholecystectomy: a regional health system's experience. Am J Surg. 2015;209(3):488-492. doi:10.1016/j.amjsurg.2014.09.023
Guzman MJ, Gitelis ME, Linn JG, et al. A model of cost reduction and standardization. Dis Colon Rectum. 2015;58(11):1104-1107. doi:10.1097/dcr.0000000000000463
Krpata DM, Haskins IN, Rosenblatt S, Grundfest S, Prabhu A, Rosen MJ. Development of a disease-based hernia program and the impact on cost for a hospital system. Ann Surg. 2018;267(2):370-374. doi:10.1097/sla.0000000000002093
Zygourakis CC, Valencia V, Moriates C, et al. Association between surgeon scorecard use and operating room costs. JAMA Surg. 2017;152(3):284. doi:10.1001/jamasurg.2016.4674
Brodsky JB. Cost savings in the operating room. Anesthesiology. 1998;88(3):834-834. doi:10.1097/00000542-199803000-00041
Tsai M. The true cost of operating room time. Arch Surg. 2011;146(7):886. doi:10.1001/archsurg.2011.1632011
Gil-Gimeno A, Laberge PY, Lemyre M, Gorak E, Maheux-Lacroix S. Morcellation during total laparoscopic hysterectomies: implications of the use of a contained bag system. J Obstet Gynaecol Can. 2020;42:839-845. doi:10.1016/j.jogc.2019.11.004
Lin Y-S. New helical incision for removal of large uteri during laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 2004;11:519-524. doi:10.1016/S1074-3804(05)60086-2
Wong WSF, Lee TCE, Lim CED. Novel vaginal “paper roll” uterine morcellation technique for removal of large (>500 g) uterus. J Minim Invasive Gynecol. 2010;17:374-378. doi:10.1016/j.jmig.2010.02.005
Cohen SL, Greenberg JA, Wang KC, et al. Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study. J Minim Invasive Gynecol. 2014;21:935-939. doi:10.1016/j.jmig.2014.06.004
Seidman MA, Oduyebo T, Muto MG, Crum CP, Nucci MR, Quade BJ. Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS ONE. 2012;7:e50058. doi:10.1371/journal.pone.0050058
Wasson M, Magtibay P, Magtibay P, Magrina J. Incidence of occult uterine malignancy following vaginal hysterectomy with morcellation. J Minim Invasive Gynecol. 2017;24(4):665-669. doi:10.1016/j.jmig.2017.01.025
American College of Obstetricians and Gynecologists. Uterine morcellation for presumed leiomyomas. Obstet Gynecol. 2021;137:552-553. doi:10.1097/AOG.0000000000004292
Favero G, Miglino G, Köhler C, et al. Vaginal morcellation inside protective pouch: a safe strategy for uterine extration in cases of bulky endometrial cancers: operative and oncological safety of the method. J Minim Invasive Gynecol. 2015;22:938-943. doi:10.1016/j.jmig.2015.04.015
Wong M, de Wilde RL, Isaacson K. Reducing the spread of occult uterine sarcoma at the time of minimally invasive gynecologic surgery. Arch Gynecol Obstet. 2018;297:285-293. doi:10.1007/s00404-017-4575-6
Montella F, Riboni F, Cosma S, et al. A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy. Surg. Endosc. 2014;28:1949-1953. doi:10.1007/s00464-014-3422-0