Risk of leakage with a new detachable multi-hard-port containment system for power morcellation during gynecologic laparoscopy: An in vitro study

Abstract Although laparoscopic surgery has been a milestone for minimally invasive surgeries, there still exists concern of the spread of morcellated tissue fragments in malignancy. Different tissue containment systems have been used in laparoscopic power morcellation. However, a risk of leakage still exists in clinical practice.In this study, we aimed to evaluate leakage and tissue dissemination associated with a new detachable multi-hard-port containment system for tissue removal during laparoscopic myomectomy morcellation. Beef tongue specimens were stained with indigo carmine dye and morcellated under laparoscopic guidance in a plastic trainer box. The morcellation test in in vitro conditions comprised two different containment systems to simulate laparoscopic power morcellation, specifically a polyurethane bag with two pipes (control group) and a detachable multi-hard-port containment system (experimental group). Insufflation pressure was set at 14 mmHg. Visual evidence of spilled tissue or dye and procedure times were recorded. Thirty trials were performed using a multi-port approach and the two tissue containment systems. The leakage rate was 0.03% (n = 30) for the experimental group and 26.6% (n = 30) for the control group (p < 0.005). Morcellation time was significantly shorter in the experimental group than that in the control group (p < 0.001). Median bag introduction time was shorter in the experimental group than that in the control group; however, removal time differences were not significant. This study quantified leakage during morcellation and the convenience provided by a new tissue containment system.