Aims: The study aimed to evaluate feasibility and safety of in-bag manual morcellation compared to uncontained power morcellation during laparoscopic myomectomy. Methods: A total of 72 women undergoing laparoscopic myomectomy were randomized into 2 treatment groups: 34 patients underwent in-bag manual morcellation (experimental group) and 38 were submitted to uncontained power morcellation (control group). The primary end point was the comparison of morcellation operative time (MOT). Total operative time (TOT), rate of intraoperative complication, and postoperative outcomes in the 2 groups were regarded as secondary outcomes. Results: Mean MOT and TOT were longer in the experimental group than in the control one (MOT: 9.47 ± 5.05 vs. 6.16 ± 7.73 min; p = 0.01; TOT: 113.24 ± 28.12 vs. 96.74 ± 33.51 min; p = 0.01). No intraoperative complications occurred in either group and no cases of bag disruption or laparotomic conversion were recorded. No significant difference in hemoglobin drop, hospital stay, and postoperative outcomes was reported between groups. Conclusion: In-bag manual morcellation appears a safe and feasible procedure and, despite slightly longer operative time, could represent an alternative to uncontained power morcellation.

1.
Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM: High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188:100-107.
2.
Evans P, Brunsell S: Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician 2007;75:1503-1508.
3.
Parker WH: Etiology, symptomatology, and diagnosis of uterine myomas. Fertil Steril 2007;87:725-736.
4.
Jin C, Hu Y, Chen XC, Zheng FY, Lin F, Zhou K, et al: Laparoscopic versus open myomectomy - a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2009;145:14-21.
5.
Kho KA, Nezhat CH: Evaluating the risks of electric uterine morcellation. JAMA 2014;311:905-906.
6.
The American College of Obstetricians and Gynecologists: Power morcellation and occult malignancy in gynecologic surgery. http://www.acog.org/Resources-And-Publications/Task-Force-and-Work-Group-Reports/Power-Morcellation-and-Occult-Malignancy-in-Gynecologic-Surgery.
7.
D'Angelo E, Prat J: Uterine sarcomas: a review. Gynecol Oncol 2010;116:131-139.
8.
Seidman MA, Oduyebo T, Muto MG, Crum CP, Nucci MR, Quade BJ: Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS One 2012;7:e50058.
9.
Oduyebo T, Rauh-Hain AJ, Meserve EE, Seidman MA, Hinchcliff E, George S, et al: The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol 2014;132:360-365.
10.
Food and Drug Administration: FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids. 2014. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm393689.htm.
11.
Seracchioli R, Manuzzi L, Vianello F, Gualerzi B, Savelli L, Paradisi R, et al: Obstetric and delivery outcome of pregnancies achieved after laparoscopic myomectomy. Fertil Steril 2006;86:159-165.
12.
Venturella R, Rocca ML, Lico D, La Ferrera N, Cirillo R, Gizzo S, et al: In-bag manual versus uncontained power morcellation for laparoscopic myomectomy: randomized controlled trial. Fertil Steril 2016;105:1369-1376.
13.
Cohen SL, Greenberg JA, Wang KC, Srouji SS, Gargiulo AR, Pozner C: Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study. J Minim Invasive Gynecol 2014;21:935-939.
14.
Cohen SL, Morris SN, Brown DN, Greenberg JA, Walsh BW, Gargiulo AR, et al: Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016;214:257.e1-e6.
15.
Vargas MV, Cohen SL, Fuchs-Weizman N, Wang KC, Manoucheri E, Vitonis AF, et al: Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol 2015;22:433-438.
16.
Cohen SL, Einarsson JI, Wang KC, Brown D, Boruta D, Scheib SA, et al: Contained power morcellation within an insufflated isolation bag. Obstet Gynecol 2014;124:491-497.
17.
Paul PG, Thomas M, Das T, Patil S, Garg R: Contained morcellation for laparoscopic myomectomy within a specially designed bag. J Minim Invasive Gynecol 2016;23:257-260.
18.
Brölmann H, Tanos V, Grimbizis G, Ind T, Philips K, van den Bosch T, et al: Options on fibroid morcellation: a literature review. Gynecol Surg 2015;12:3-15.
19.
Rimbach S, Holzknecht A, Schmedler C, Nemes C, Offner F: First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy. Arch Gynecol Obstet 2016;294:83-93.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.