AB042. SOH22ABS182. In-bag laparoscopic morcellation: a safe technique to remove large gynaecological specimens

Background: Laparoscopic approach is a mainstay of benign gynaecological surgery, as it is associated with less pain, fewer wound complications, reduced length of stay in hospital, and quicker return to normal activities of daily living. Retrieval of large gynaecological specimens from the abdomen at the time of a laparoscopic procedure can be complicated by need to convert to laparotomy, spill of specimen into the abdominal cavity, and seeding of an undiagnosed malignancy. In the instance of conversion to laparotomy, length of stay in hospital is extended, analgesic requirements are increased, and recovery may be prolonged. Morcellation is a technique used to remove large specimens in a laparoscopic manner, though there are recent concerns about disseminating occult malignancies into the abdominal cavity. In-bag morcellation offers a possible solution for removal of large specimens at the time of laparoscopy, with a reduced risk of disseminating benign and malignant lesions.

Methods: A patient was scheduled to undergo operative laparoscopic surgery to remove a large ovarian fibroma. The pedunculated fibroma was removed from the ovary with Ligasure, and then placed in a specially-designed Espiner bag.

Results: Pneumoperitoneum within the bag was achieved, and direct visualisation of the specimen allowed for safe morcellation with the LiNA Xcise morcellator device. The large (20 cm) solid mass was removed without spill into the abdomen with maximum incision size of 12 mm.

Conclusions: We demonstrate a technique for safe laparoscopic retrieval of large specimens from the patient abdomen, in the form of a video presentation of the in-bag morcellation of an ovarian fibroma.

Keywords: Laparoscopy; gynaecology; morcellation; laparoscopic surgery; minimal access surgery (MAS)