Group compares morcellation techniques for evidence of tissue spillage

An isolation bag for morcellation provides the best specimen containment, according to a study presented at AAGL. In an effort to help establish best practices for patient safety during morcellation procedures, James A. Greenberg, MD, led a team of researchers in a pilot study testing techniques for contained tissue extraction (CTE), looking for evidence of bag integrity and failure.

Dr. Greenberg presented the results of the study during an open communications session at the 43rd AAGL Global Congress on Minimally Invasive Gynecology on Wednesday, November 14.

Dr. Greenberg is Chief, Division of Gynecology, Brigham & Women’s Faulkner Hospital, and Associate Professor, Harvard Medical School, Boston, Massachusetts.

Indigo carmine-stained tissue being extracted from within an insuflated bag

He and a team of colleagues evaluated the risk of leakage and tissue dissemination with 3 in-bag morcellation (IBM) techniques. In a hospital simulation lab, they stained beef tongue specimens with indigo-carmine dye and morcellated them with varying techniques under laparoscopic guidance within a plastic box trainer.

The techniques were a stitched-sealed rip-stop nylon bag with a multi-port approach; an isolation bag with a multiport approach; and an isolation bag with a single-site approach. Open tissue morcellation was performed as a control. Visual evidence of spilled tissue or dye was recorded, and fluid washings from the box trainer were sent for cytologic analysis.

Four trials of each contained morcellation method were performed and compared to the open morcellation control. Dye spill was noted in only 1 of the 12 contained morcellation trials, whereas spillage was visualized from a seam in 1 of the 4 stitched-sealed rip-stop nylon bags with high insufflation pressure-even prior to morcellation of the specimen.

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The only trial that resulted in gross tissue chips apparent in the box trainer following morcellation was in the open morcellation washings and the washings from the trial with dye spill. Muscle cells were not seen cytologically in any of the other samples.

Simulation model setup using a plastic storage bin

Dr. Greenberg noted that further studies are needed to corroborate the findings in vivo, and to evaluate use of alternate bag options for specimen containment. In an interview, Dr. Greenberg, who is product reviewer for Contemporary OB/GYN, told the magazine, “Our group is focused on finding the safest technological alternatives for our patients. Part of that commitment involves evaluating our clinical initiatives in the lab. We created this simulation model as a first step in helping us to better evaluate CTE technologies as they evolve.”

Greenberg JA, Cohen SL, Wang KC, et al. Risk of leakage and tissue dissemination with various in-bag morcellation (IBM) techniques: in vitro pilot study. Paper presented at: 43rd AAGL Global Congress; November 2014; Vancouver, Canada.

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