Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA.
Division of Minimally Invasive Gynecologic Surgery, Newton Wellesley Hospital, Newton, MA.
Am J Obstet Gynecol. 2016 Feb;214(2):257.e1-257.e6. doi: 10.1016/j.ajog.2015.08.076. Epub 2015 Sep 6.
Safe tissue removal is a challenge for minimally invasive procedures such as myomectomy, supracervical hysterectomy, or total hysterectomy of a large uterine specimen. There is concern regarding disruption or dissemination of tissue during this process, which may be of particular significance in cases of undetected malignancy. Contained tissue extraction techniques have been developed in an effort to mitigate morcellation-related risks.
The objective of the study was to quantify perioperative outcomes of contained tissue extraction using power morcellation, specifically evaluating parameters of tissue or fluid leakage from within the containment system.
This was a study including a multicenter prospective cohort of adult women who underwent minimally invasive hysterectomy or myomectomy using a contained power morcellation technique. Blue dye was applied to the tissue specimen prior to removal to help identify cases of fluid or tissue leakage from within the containment system.
A total of 76 patients successfully underwent the contained power morcellation protocol. Mean time for the contained morcellation procedure was 30.2 minutes (±22.4). The mean hysterectomy specimen weight was 480.1 g (±359.1), and mean myomectomy specimen weight was 239.1 g (±229.7). The vast majority of patients (73.7%) were discharged home the same day of surgery. Final pathological diagnosis was benign in all cases. Spillage of dye or tissue was noted in 7 cases (9.2%), although containment bags were intact in each of these instances.
Findings are consistent with prior work demonstrating the feasibility of contained tissue extraction; however, further refinement of this technique is warranted.
微创手术如子宫肌瘤切除术、子宫颈以上子宫切除术或大子宫标本全子宫切除术，安全切除组织是一个挑战。在这个过程中，组织的破坏或传播令人担忧，在未检测到恶性肿瘤的情况下，这种情况可能具有特殊意义。为了降低与组织切碎相关的风险，已经开发出了包含组织提取技术。
本研究的目的是量化使用电动组织切碎器进行包含组织提取的围手术期结果，特别是评估包含系统内组织或液体泄漏的参数。
这是一项包括接受微创子宫切除术或子宫肌瘤切除术的成年女性的多中心前瞻性队列研究，使用包含电动组织切碎器技术。在切除前，将蓝色染料应用于组织标本，以帮助识别包含系统内的液体或组织泄漏的病例。
共有 76 名患者成功完成了包含电动组织切碎器协议。包含电动切碎过程的平均时间为 30.2 分钟（±22.4）。子宫切除术标本的平均重量为 480.1 克（±359.1），子宫肌瘤切除术标本的平均重量为 239.1 克（±229.7）。绝大多数患者（73.7%）在手术当天出院回家。所有病例的最终病理诊断均为良性。尽管在每个病例中包含袋均保持完整，但有 7 例（9.2%）观察到染料或组织溢出。
这些发现与先前的工作一致，证明了包含组织提取的可行性；然而，需要进一步改进这项技术。
