Department of Obstetrics and Gynecology, China-Japan Friendship Hospital, Beijing, 100029, China.
BMC Surg. 2023 Jul 31;23(1):213. doi: 10.1186/s12893-023-02124-1.
Laparoscopic surgery has been a milestone for minimally invasive surgeries. But safe removal of large uterine tissue is a challenge for minimally invasive procedures, and there still exists concern about the dissemination of benign or occult malignant uterine tissue during the use of the morcellator. Different tissue containment systems have been used in laparoscopic power morcellation. However, a risk of leakage still exists in clinical practice. In this study, we aimed to evaluate leakage and tissue dissemination associated with a new detachable multi-hard-port containment system for tissue removal during laparoscopic myomectomy morcellation.
Beef tongue specimens were stained with methylene blue solution and morcellated in a plastic trainer box under laparoscopic guidance. The morcellation test in vitro conditions comprised two different containment systems to simulate laparoscopic power morcellation, specifically a polyurethane bag with two pipes (control group) and a detachable multi-hard-port containment system (experimental group). Insufflation pressure was set at 14 mmHg. Three methods are used to detect the leakage The procedure times were recorded. Thirty trials were performed using a multi-port approach and the two tissue containment systems.
The leakage rate was 0.03% (n = 30) for the experimental group and 26.6% (n = 30) for the control group (p < 0.005). Morcellation time was significantly shorter in the experimental group than in the control group (p < 0.001). Median bag introduction time was shorter in the experimental group than in the control group; however, removal time differences were not significant.
This study quantified the low leakage rate during morcellation and the improved convenience of operation provided by a new tissue containment system.
腹腔镜手术是微创外科的一个里程碑。但是，对于微创手术来说，安全地切除大的子宫组织仍然是一个挑战，而且在使用组织切碎器时，仍然存在良性或隐匿性恶性子宫组织播散的担忧。不同的组织容纳系统已被用于腹腔镜动力组织切碎术。然而，在临床实践中仍然存在泄漏的风险。在这项研究中，我们旨在评估在腹腔镜子宫肌瘤切除术的动力组织切碎术中使用新的可拆卸多硬端口组织容纳系统与组织切除相关的泄漏和组织播散。
将牛舌标本用亚甲蓝溶液染色，在腹腔镜引导下用塑料训练箱进行切碎。体外的切碎试验包括两种不同的容纳系统，以模拟腹腔镜动力组织切碎术，具体为带有两个管的聚氨酯袋（对照组）和可拆卸的多硬端口容纳系统（实验组）。充气压力设定为 14mmHg。采用三种方法检测泄漏，记录手术时间。使用多端口方法和两种组织容纳系统进行了 30 次试验。
实验组的泄漏率为 0.03%（n=30），对照组为 26.6%（n=30）（p<0.005）。实验组的切碎时间明显短于对照组（p<0.001）。实验组的袋子引入时间中位数短于对照组；然而，取出时间差异不显著。
本研究量化了组织切碎过程中的低泄漏率和新组织容纳系统操作便利性的提高。
