Page 16 - Peer Reviewed Laparoscopic Jornal

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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