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Nuzhat Amer et al

          enlarging the umbilical port. In this method, they bring the  A study was done by Chang et al in which they compared
          mouth of sac out of the port with help of atraumatic grasper.  the results of simultaneous laparoscopic uterine artery
          The specimen then is morcellated with Kocher’s clamps to  ligation and laparoscopic myomectomy for symptomatic
          avoid intra-abdominal spillage. No intraoperative or  myomas with a without in situ morcellation. No major
          immediate postoperative complication related to technique  complication was noted during morcellation in both groups.
          of specimen extraction was noted. No trocar site hernia or  Improvement of symptoms was similar in both groups.
          metastasis was observed. 13                         Follow-up was done until 24 months postoperatively. They
             A study was done by Kao et al who described homemade  observed shorter surgical time in the group in which in situ
          specimen retrieval bag (sterile glove) for laparoscopic tissue  morcellation of the myoma was done without enucleation. 17
          retrieval. A total of 135 patients underwent laparoscopic  In a retrospective study done by Rosenblatt et al,
          surgery and tissue specimen were retrieved using bag made  51 patients underwent laparoscopic supracervical
          with surgical gloves. No postoperative complications were  hysterectomy with transcervical morcellation. They found
          noted such wound infection or wound metastasis. They  this procedure efficient and safe. 18
          found this bag easy to prepare, easy to use, cost effective
          and with short learning curve. 14                   Tissue Retrieval in Hand-Assisted
             Ganpule et al have described a novel cost effective  Laparoscopic Surgery
          specimen retrieval bag (Nadiad bag) to retrieve specimen  Hand-assisted laparoscopic living donor nephrectomy was
          in laparoscopic surgery. They used this bag in 40 patients.  done in 100 cases in which donor kidney was retrieved by
          They found this bag to be inexpensive and easy to use. This  surgeon’s hand after laparoscopic nephrectomy through a
          bag needs less force for traction and is tumor seeding is  specially designed hand assist device. Advantage of this
          less. Urethral catheter used in this techniques keeps the bag  technique was that there was shorter hospital stay, less ileus
          open during entrapment. 6                           and postoperative pain. 9
             Schellpfeffer described a novel laparoscopic tissue
          retrieval device in which a forceps was used in cases where  In a study done by Kakinoki et al, 28 patients underwent
          endobag could not be removed with axial traction. Out of  for HALS splenectomy. Out of these, one patient suffered
          42 patients in eight, the retrieval was not successful even  from intraoperative hemorrhage and two patients had
                                                                                        19
          with the forceps and it was due to the large size of the mass.  postoperative wound infection.
          In these cases, the port size had to be enlarged to remove  Tissue Retrieval through Colpotomy
          the mass. In 34 patients, the procedure was successful  (Transvaginal)
          without and significant complications. Three patients
          developed subumbilical trocar site superficial infection  Transvaginal removal of large organs, like spleen, kidney
          which was managed conservatively. No incisional hernia  and gallbladder with large stones, has been performed
          was noted in early postoperative period. No adverse outcome  successfully. 20
          was noted on long term follow-up (until 5 years). 3    Mofid et al studied 1,281 patients who underwent notes
                                                              procedure from 2007 to 2011. In 222 patients, cholecystec-
          Tissue Retrieval by Morcellation                    tomy of appendectomy was done through transvaginal route.

          Chen et al did laparoscopic myomectomy and morcellator  Twelve patients out of these need additional abdominal
          was used to remove the tissue. They grouped the patients  trocar for drainage system, 0.7% intraoperative compli-
          into three groups according to the weight of fibroid. They  cations while two patients had postoperative complications,
          observed shorter surgical time in groups with lower fibroid  (abscess in pouch of Douglas and biliary fistula). A total of
          weight. Patients were followed for until 3 months. They  88% patients did not have any postoperative complications,
          advised to do simultaneous enucleation and  in situ  like vaginal bleeding, incisional hernia, wound infection or
          morcellation as this minimize the operative time and missing  sexual dysfunction. 21
          of myoma. They did not report any late postoperative   A 2 years prospective study done by Pillai and Yoong
          complications. 15                                   in which they studied the use of endobag to remove the
             Another study was done by Zhang et al in which   benign ovarian mass through colpotomy. There was no
          26 patients underwent laparoscopic myomectomy. Simul-  spillage of the cyst and no intraoperative or postoperative
          taneous morcellator in situ was used to remove fibroids  complication observed. 5
          which were more than 9 cm in size. There were no serious  Panait et al performed transvaginal notes procedure on
          complications and hospital stay was not different for fibroids  17 morbid obese patients. There was no significant
          of different sizes. 16                              difference in operative time in morbid obese patients. These
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