A Less Risky Approach to Power Morcellation for Hysterectomy and Myomectomy?

Does performing it within a bag make this minimally invasive surgery safer?

As cases of disseminated uterine sarcoma associated with minimally invasive hysterectomy using power morcellation continue to generate concern and the FDA finalizes guidance regarding its use, high-volume gynecologic surgeons with specialized training in minimally invasive surgery have described a technique for power morcellation contained within an isolation bag. In this retrospective cohort study, 73 cases of hysterectomy and myomectomy were performed between January 2013 and April 2014 employing power morcellation under laparoscopic visualization within an insufflated a 50×50-cm clear plastic bag.

Inspection of the bag by the surgeon following specimen extraction revealed no visible perforations except, in cases involving multiport procedures, punctures associated with use of 5-mm trocars. Median operative time was 114 minutes, estimated blood loss 50 mL, and specimen weight 257 g. Complications were few, and none appeared related to this off-label use of the bag for specimen extraction. More than 75% of patients were discharged home the same day.

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