Department of Obstetrics and Gynecology, Community Hospital Dormagen, University of Witten-Herdecke, Dr.-Geldmacher-St. 20, 41540, Dormagen, Germany.
Department of Obstetrics and Gynecology, Klinikum Ansbach, Ansbach, Germany.
Sci Rep. 2021 Oct 22;11(1):20882. doi: 10.1038/s41598-021-99934-1.
Electromechanical morcellation-so called power morcellation-is a minimally invasive approach to remove bulky lesions such as uterine fibroids. The spread of benign and malignant tissue due to morcellation is a major concern that might limit the use of laparoscopic interventions. We present an in vitro evaluation of the safety characteristics of a four-port endobag with closable trocar sleeves, and describe physical properties of the bag that may or may not allow passage through the hole. In addition, we report our preliminary experience of this tool when used for laparoscopic supracervical hysterectomies. The behavior of the endobag during the extraction process was analyzed by extracting opened and re-sealed bags filled with 20 ml blue dye solution through a wooden template, with incisions measuring 10 to 24 mm. The endobag was used in 50 subtotal hysterectomies during the morcellation procedure. In the in vitro test, no dye loss was recorded for incisions measuring 11-24 mm. The mean force required to pull the bag through the template was inversely proportional to incision size. No bag rupture occurred during the surgical procedures. The mean time taken to prepare the bag for morcellation was 7.1 min (range, 4-14 min), the mean duration of subtotal hysterectomy was 53.4 min (range, 20-194 min). The mean weight of the removed body of the uterus was 113.8 g (range, 13-896 g), the mean weight of tissue and fluid remaining in the bag after morcellation 7.9 g (range, 0-39 g). In the in vitro setting, the improved endobag signifies greater patient safety during bag extraction, along with less tissue traumatization due to a smaller incision in the abdominal wall. The improved ergonomic features of the bag permit the insertion of three trocars in the lower abdomen and avoid closure of unused access ports. Our preliminary experience has shown that the device can be used under routine conditions. Failure rates will be evaluated in future studies.
电动切割术，又称电动粉碎术，是一种微创方法，用于切除体积较大的病变，如子宫肌瘤。由于切割术导致良性和恶性组织扩散，这是一个主要关注点，可能会限制腹腔镜干预的使用。我们介绍了一种带有可关闭套管的四孔内镜袋的安全性特征的体外评估，并描述了该袋可能或不可能通过孔的物理特性。此外，我们还报告了这种工具在腹腔镜子宫次全切除术中的初步使用经验。通过在木制模板上提取装满 20ml 蓝色染料溶液的已打开和重新密封的袋子，分析了提取过程中内镜袋的行为，切口尺寸为 10 至 24mm。在粉碎过程中，该内镜袋在 50 例次全子宫切除术被使用。在体外试验中，切口尺寸为 11-24mm 时未记录到染料丢失。将袋子通过模板拉出所需的平均力与切口尺寸成反比。在手术过程中未发生袋破裂。为粉碎术准备袋子的平均时间为 7.1 分钟（范围 4-14 分钟），次全子宫切除术的平均时间为 53.4 分钟（范围 20-194 分钟）。切除子宫体的平均重量为 113.8g（范围 13-896g），粉碎术后留在袋子中的组织和液体的平均重量为 7.9g（范围 0-39g）。在体外环境中，改进后的内镜袋在袋子提取过程中提高了患者安全性，同时由于腹壁切口较小，减少了组织创伤。袋子的改进型人体工程学特征允许在腹部的下侧插入三个套管，并避免关闭未使用的接入端口。我们的初步经验表明，该设备可以在常规条件下使用。未来的研究将评估设备的失败率。
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