Clinical Observation of manual Semi-isolation Specimen Bag In the process of transumbilical single port laparoscopy surgery for Benign Ovarian Tumors

Clinical Observation of manual Semi-isolation Specimen Bag In the process of transumbilical single port laparoscopy surgery for Benign Ovarian Tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Observation of manual Semi-isolation Specimen Bag In the process of transumbilical single port laparoscopy surgery for Benign Ovarian Tumors Yujie Chen, Xuequn Zheng, Liju Huang, Lifang Lan, Daidong Yuan, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4753374/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The aim of this study was to demonstrate a manual semi-isolation specimen bag, and to compare the spillage rate and surgical outcomes between the usage this specimen bag in the process of transumbilical single-port laparoscopy and the conventional technique in laparoscopy for ovarian tumors (less than 12 cm in diameter) presumed to be benign. Methods A retrospective analysis was conducted on 75 patients who underwent laparoscopic resection of ovarian tumors at the People's Hospital of Liuzhou, Guangxi, China, from October 2022 to October 2023. Among them, 40 cases were treated with transumbilical single-port laparoscopy combined with the manual semi-isolation specimen bag (study group), and 35 cases were treated with traditional multi-port laparoscopy (control group). The average total operation time, tumor resection time, time for specimen retrieval after tumor resection, and postoperative recovery were observed in both groups. Results The two groups had similar baseline characteristics. The tumor excision time of control group was shorter than in the study group (42.46 ± 12.77 min vs. 51.88 ± 13.06 min). but the time of specimen removal after tumor excision were significantly shorter in the study group compared to those in the control group(25.98 ± 5.40 min vs. 36.66 ± 15.12 min).However, the average total operation time was similar (101.54 ± 32.16 min vs. 101.28 ± 18.46 min༉. Other surgical outcomes, which were similar between two groups, included length of hospital stay and VAS score at 12h postoperatively. There were no postoperative morbidity in the study group meanwhile 2 in the control group. Conclusion The use of the manual semi-isolation specimen bag in the process of Transumbilical single port laparoscopy surgery Semi-isolation Specimen retrieval Leakage༛Benign ovarian tumors Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Laparoscopic surgery is currently the main surgical approach for benign gynecological tumors [ 1 ] . With the continuous advancement of surgical equipment and techniques, single-incision laparoendoscopic surgery (SILS) has emerged. SILS involves placing surgical instruments through a single incision at the umbilicus to perform the surgery, resulting in minimal trauma and better cosmetic results. It is particularly suitable for patients seeking minimal scarring, including those undergoing benign ovarian tumor resection and uterine myomas removal [ 2 ] . However, single-incision laparoscopic surgery faces challenges such as the convenience of operation and tumour spillage, as well as issues like the instrument crowding, loss of triangulation, cylindrical field of view, and unstable surgical field[Uppal S, Frumovitz M, Escobar P, Ramirez PT. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol. 2011; 18(1):12–23.]. In ovarian cystectomy, tumor rupture and tumor tissue leakage may occur due to the operational challenges, such as the instrument crowding and the loss of triangulation. The " tumor-free " principle, first proposed by Cole in 1954, has become a fundamental principle of oncologic surgery [ 3 ] . It involves a series of recommendations during tumor surgery to reduce and prevent the shedding, implantation, and dissemination of tumor cells [ 4 ] . Here, we report a self-prepared specimen bag for single-incision laparoscopic surgery, which addresses the challenges of single-incision laparoscopic surgery by facilitating specimen retrieval and semi-isolating the operating field. In this study, we retrospectively compared the clinical outcomes, time costs, and economic costs of single-incision laparoscopic surgery and conventional multi-port laparoscopic surgery for benign ovarian tumors treated at our institution from October 2022 to October 2023. Materials and Method 1. Material The self-designed specimen bag was patented in 2019 (patent number CN 211187374 U) and has been applied clinically. Ethical approval was obtained from the local ethics committee of the Liuzhou people’s Hospital, Liuzhou, Guangxi, China (KY2024-063-01), and informed consent was obtained. All protocols were conducted under the principles of the Declaration of Helsinki. The manual specimen bag was prepared as follows: it was derived from the sterile packaging bag of a disinfection pad. After removing the disinfection pad, the packaging bag is retained and kept sterile, with dimensions of approximately 16cm×16cm. One end of the packaging bag is already closed, while the other end is folded outward by about 1-1.5cm to form a tunnel. A size 5 urinary catheter is then inserted and securely sutured to the tunnel using size 7 sutures. This creates a specimen retrieval bag that automatically expands upon use and is disposed of after single use, following medical waste disposal protocols. 2. Method Observation Group: A self-designed specimen bag was utilized in conjunction with single-incision laparoscopic surgery. A 2.5cm incision was made at the umbilicus, and the skin, fat, rectus sheath, and peritoneal layers were sequentially dissected to access the abdominal cavity. An integrated puncture pathway was inserted, and pneumoperitoneum was established to facilitate comprehensive exploration of the pelvic and abdominal cavities. The specimen bag was fabricated by nursing staff as described above. The specimen bag was inserted through the puncture pathway, and it was observed that the bag could spontaneously form a circular entrance in the abdominal cavity. Adhesions in the pelvic and abdominal cavities were separated, and the specimen bag was positioned at the uterorectal pouch with its opening facing upwards. The enlarged ovaries were placed inside the specimen bag, and tumor excision was performed within the bag. Complete excision was achieved in 28 cases, with tumor rupture occurring in 12 cases during excision, all of which were collected within the specimen bag without any spillage. The specimen bag, along with the tumor, was then retrieved intact from the umbilical incision without any ruptures or spillage. The puncture pathway was re-inserted to establish pneumoperitoneum, and hemostasis and closure of ovarian tissue were performed. The abdominal cavity was cleared, and the incision was closed. Control Group: Conventional multi-port laparoscopic surgery was performed. A 1cm incision was made at the umbilical circumference, and pneumoperitoneum was established using a Veress needle. Trocars were inserted through the umbilical ring, and two additional puncture points were made along the left subcostal line and the left iliac crest line (1/3 from the outer edge, 0.5-1cm in length). Ovarian tumor resection and suturing were performed using standard techniques. Specimens were placed in conventional specimen bags and retrieved through the lower left abdominal puncture hole. The abdominal cavity was cleared, and the incisions were closed. 3. Data Collection A retrospective collection of cases undergoing laparoscopic adnexal surgery at the People's Hospital of Liuzhou from October 2022 to October 2023. Preoperative assessment included detailed documentation of demographic characteristics (age, body mass index, history of pelvic surgery, type of delivery, and parity), Doppler ultrasound examination, serum CA-125 levels, and pelvic magnetic resonance imaging (when necessary). Past medical history, including previous cesarean section, appendectomy, or any pelvic surgical history, was recorded. Retrieve and record the following data from electronic medical records: maximum size (in centimeters), location, intraoperative and postoperative complications of ovarian tumors, total operation time, tumor excision time, time from excision to specimen retrieval, length of hospital stay, postoperative visual analogue scale (VAS) pain scores, pain assessment, average cost, and postoperative morbidity. Total operation time is defined as the time from the first incision to the completion of closure of the last incision. Tumor excision time refers to the time from incision of the tumor capsule to complete excision of the tumor. The time from completion of tumor excision to complete retrieval of the specimen from the incision site is defined as the time from excision to specimen retrieval. Hospital stay is defined as the number of hours hospitalized after surgery. VAS scores are obtained at 12 hours and 24 hours postoperatively (with 1 indicating mild pain and 10 indicating severe pain). There is currently no authoritative definition for postoperative morbidity; typically, it refers to having a body temperature of 38°C or higher measured at least twice daily from the day after surgery until discharge. 4. Statistics SPSS 20.0 software was used for data analysis. Continuous data were expressed as mean ± standard deviation (x ± s), and Student’s t-test was used for comparison. Categorical data were expressed as percentages, and the chi-square test was used for comparison. A p-value of less than 0.05 was considered statistically significant. Result A total of 75 patients were included in the final analysis, and demographic characteristics and baseline features were similar between the two groups. All patients underwent successful laparoscopic surgery without excessive intraoperative bleeding requiring transfusion (Table 1 ). The maximum diameters of tumors in the two groups were 11.5 cm (4.8 cm-11.5 cm) and 11 cm (4.5 cm-11 cm), respectively, with average sizes being similar (73.57 ± 18.34 cm vs. 77.23 ± 18.36 cm, P = 0.393). The majority of tumors were benign, with teratomas accounting for 57.14% (20/35) and 65.00% (26/40) in each group, respectively. Serous cyst adenomas accounted for 25.71% (9/35) and 17.50% (7/40), mucinous cystadenomas accounted for 8.57% (3/35) and 10.00% (4/40), other benign types accounted for 5.71% (2/35) and 5.00% (2/40), and borderline tumors accounted for 2.86% (1/35) and 2.50% (1/40), respectively. The average total operation time was similar (101.54 ± 32.16 min vs. 101.28 ± 18.46 min, P = 0.964). In the traditional multi-port laparoscopic surgery group, tumor excision time was shorter than in the single-incision surgery group (42.46 ± 12.77 min vs. 51.88 ± 13.06 min, P = 0.002). However, in the specimen retrieval phase, the manual specimen bag in the single-incision laparoscopic surgery group facilitated complete retrieval of specimens, and it took less time (25.98 ± 5.40 min vs. 36.66 ± 15.12 min, P = 0.000). During tumor excision, the majority of specimens were completely contained within the specimen bag without tissue leakage. Postoperative examination using a "leakage test" or "inflation test" confirmed the integrity of the specimen bag. There were no serious postoperative complications in either group. In the observation group, 2 cases (5.0%) of patients experienced redness and slight exudation at the abdominal incision site postoperatively, which improved after local wound care reinforcement, without requiring re-suturing for poor wound healing (Grade II). Both groups of patients did not require postoperative analgesic pumps, and pain (VAS) scores ranged from 3 to 5 (4.2 ± 1.6 vs. 3.9 ± 1.3, P = 0.881). There was no statistically significant difference in postoperative morbidity between the two groups, but no cases occurred in the observation group meanwhile 2 in the control group. (Table 2 ). The specimen bag used in the observation group only required a disposable urinary catheter, costing 2.6 RMB, while the commercial price of specimen bags ranged from 100 to 350 RMB [ 5 ] . Table 1 General preoperative data in both groups Control Group(n = 35) Study Group(n = 40) P-value age 38.66 ± 14.19 38.66 ± 14.19 0.919 BMI(kg/㎡) 23.17 ± 2.27 23.24 ± 2.4 0.902 history of previous pelvic and abdominal surgery (%) 15 (42.9) 17 (42.5) 0.975 Table 2 The comparison of the intraoperative and postoperative conditions between the two groups Control Group(n = 35) Study Group(n = 40) P-value Average ovarian tumor size(cm) 73.57 ± 18.34 77.23 ± 18.36 0.393 Tumor type 0.933 teratomas 57.14% (20/35) 65.00% (26/40) Serous cyst adenomas 25.71% (9/35) 17.50% (7/40) mucinous cystadenomas 8.57% (3/35) 10.00% (4/40) other benign types 5.71% (2/35) 5.00% (2/40) borderline tumors 2.86% (1/35) 2.50% (1/40) total operative time( min) 101.54 ± 32.16 101.28 ± 18.46 0.964 tumor excision time(min) 42.46 ± 12.77 51.88 ± 13.06 0.002 time of specimen removal after tumor excision(min) 36.66 ± 15.12 25.98 ± 5.40 0.000 length of stay(天) 6.51 ± 0.98 6.55 ± 1.08 0.882 VAS 4.2 ± 1.6 3.9 ± 1.3 0.881 postoperative morbidity 2 0 Discussion Single-port laparoscopy, as an advanced minimally invasive technique developed in recent years, offers advantages such as minimal trauma, reduced postoperative pain, and faster recovery [ 6 ] . Additionally, the single-port incision typically ranges from 2.5 to 3 cm, allowing for easier and more complete specimen retrieval, particularly for solid components within ovarian tumors, such as skin, hair, and bony elements, which are less easily dissected tissues. This facilitates specimen retrieval through the umbilical incision, effectively saving surgical time. Single-port laparoscopic surgery presents specific challenges compared to traditional multi-port laparoscopic surgery, primarily related to maintaining pneumoperitoneum, adequate traction for exposure, instrument collisions, collisions between instruments and the camera, and limited maneuverability, necessitating a considerable learning curve for beginners [ 7 ] . In patients undergoing single-port laparoscopic ovarian tumor resection, the proportion of cyst rupture due to inexperienced operators may be slightly higher than in traditional laparoscopic surgery. Ovarian tumors are common tumors of the female reproductive organs. Due to their anatomical structure being relatively isolated from vital organs and structures, they have become one of the diseases early applied in single-port laparoscopy. Pathologically, benign ovarian tumors exhibit diverse types, with common pathological types including ovarian endometrioma, mature teratoma, serous cystadenoma, and mucinous cystadenoma. Ovarian endometrioma is characterized by invasive growth and a tendency for recurrence, while mucinous cystadenoma exhibits characteristics of implantation metastasis and recurrence. Improper intraoperative handling of these two types of benign ovarian tumors may lead to postoperative recurrence. Mature teratomas of the ovary typically contain abundant hair and adipose tissue, and improper intraoperative handling may lead to pelvic adhesions postoperatively. Before pathological confirmation, the possibility of malignant tumors cannot be completely ruled out [ 8 ] . In our clinical data, mature teratoma is the most common type of ovarian tumor encountered during laparoscopic surgery. Despite thorough preoperative assessments, borderline ovarian tumors discovered intraoperatively still account for a certain proportion. Therefore, tumor isolation should not be limited to the specimen retrieval phase but should extend throughout the entire surgical process. These challenges highlight the need to address the "no tumor left behind" principle during surgery. Kisu et al. reported the use of the Alexis Contained Extraction System for specimen collection in laparoscopic surgery, which allows for complete abdominal isolation during specimen retrieval, with a market price of approximately $ 40 [ 9 ] . Bao Huiqiong et al. reported the use of the TKBAG minimally invasive surgical tissue extraction device, which is inserted through the umbilicus for tissue separation and retrieval within the bag, with a market price of around 500 RMB [ 10 ] . Some articles have reported the use of latex gloves as specimen retrieval bags during surgery [ 11 , 12 ] . However, latex gloves havea certain degree of elastic recoil and may not maintain sufficient tension within the abdominal cavity to provide effective isolation. In this study, we propose a semi-isolation specimen bag marked with an opening, which is easy to unfold under laparoscopy. With a diameter of approximately 12 cm and a depth of around 12 cm, it can be used for surgeries involving ovarian tumors of about 10 cm in size. Under single-port laparoscopic surgery, pulling the opening can easily support and fix the bag under the tumor, and after tumor excision, the bag mouth can be easily gathered for retrieval. Our data show that although the tumor excision time is longer than that of traditional multi-port laparoscopic surgery, the time for specimen retrieval after tumor excision is significantly shortened when using the single-port laparoscopic approach combined with the specimen bag. Moreover, the overall duration of surgery is not prolonged. The use of this manual specimen bag significantly reduces tissue leakage, maintains a clean surgical field, and shortens the time required for rinsing the abdominal cavity, leading to a lower postoperative morbidity rate observed in our cases. Based on our practice, we summarize the advantages of the manual semi-isolation specimen retrieval bag under single-port laparoscopy as follows: 1. Combining the semi-isolation specimen retrieval bag with single-port laparoscopic surgery allows for intraoperative isolation of the surgical field before tumor dissection, enabling direct retrieval into the bag even if the tumor ruptures, with no cases of bag rupture observed. This reduces tissue fragmentation and fully embodies the principle of no tumor left behind; 2. Practicality: Easy to learn and use, conducive to promotion, with minimal additional cost of consumables, suitable for implementation in grassroots hospitals; 3. Aesthetic appeal: Fully utilizes the aesthetic advantages of single-port laparoscopy and minimally invasive techniques, without the need for additional access channels; 4. The use of this isolation bag reduces the tension of the operating physician, facilitates the training of young physicians, and effectively shortens the learning curve for single-port laparoscopy. The combination of single-port laparoscopy with this manual specimen bag shows promising applications and effective tumor defense for benign ovarian tumors < 12 cm in size. However, accommodating and extracting large specimens remains a major challenge. Declarations Ethical approval and consent to participate The authors are accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013). The research design was approved by the Ethics Committee (No. Lunshen-2011-KY-2022-063-01; April 7,2011).All patients provided written informed consent. Ethical Approval and Consent to Participate This study has been approved by the Ethics Committee of Liuzhou People's Hospital. All participants have provided informed consent for the scientific use of medical data. Consent for publication Not applicable. Data availability The dataset generated and/or analyzed in this study can be obtained from the corresponding authors upon reasonable request. Conflicts of interest The authors have no potential conflicts of interest to report. Funding Guangxi Science and Technology Plan Project (Guangxi Clinical Research Center for Obstetrics and Gynecology，GuiKe AD22035223） Authors' contributions Yujie Chen and Wenjuan Yi wrote the main manuscript text, Xuequn Zheng, Liju Huang, and Lifeng Lan prepared figures, and Daidong Yuan took photos. Fei Yu conducted the statistical analysis, and all authors reviewed the manuscript. Acknowledgement Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available due to the data belonging to the hospital database, but are available from the corresponding author on reasonable request. Ethical approval was obtained from the local ethics committee of the Liuzhou people’s Hospital , Liuzhou, Guangxi, China (KY2024-063-01), and informed consent was obtained. All protocols were conducted under the principles of the Declaration of Helsinki. Inclusion criteria were determined as follows; age between 18 and 55 years, body mass index (BMI) 18–40 kg /m2 , and the presence of a . References Van Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JM. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev. 2019;8(8):CD012858. Uppal S, Frumovitz M, Escobar P, Ramirez PT. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol. 2011;18(1):12–23. Atkin G, Chopada A, Mitchell I. Colorectal cancer metastasis: in the surgeon's hands? Int Semin Surg Oncol. 2005;2(1):5. Stentz NC, Cooney LG, Sammel M, et al. Changes in Myomectomy Practice After the U.S. Food and Drug Administration Safety Communication on Power Morcellation. Obstet Gynecol. 2017;129(6):1007–13. Deshmukh CS, Ganpule AP, Islam MR, et al. Laparoscopic and robotic specimen retrieval system (Modified Nadiad Bag): Validation and cost-effectiveness study model. J Minim Access Surg. 2019;15(4):305–10. Kilani R. Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting. Gynecol Surg. 2018;15(1):16. Boruta DM. Laparoendoscopic single-site surgery in gynecologic oncology: An update. Gynecol Oncol. 2016;141(3):616–23. Nan ZHANG, Wen DI. Tumor-free principle in surgery for benignovarian tumors. Chin J Practical Gynecol Obstet. 2023;39(1):25–7. Kisu I, Banno K, Tokuoka A, et al. Technique for transvaginal removal of large specimen using an Alexis Contained Extraction System during laparoscopic hysterectomy. Obstet Gynecol Sci. 2022;65(3):283–5. Bao H, Xun D. Application of transumbilical specimen retrieval technique in laparoscopic myomectomy. J Practical Obstet Gynecol. 2020;36(6):475–7. Güven CM. Uysal. In-bag abdominal manual morcellation versus contained power morcellation in laparoscopic myomectomy: a comparison of surgical outcomes and costs. BMC Surg. 2023;23(1):106. Yuan P, Shan L, Yang X, et al. The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy. Am J Obstet Gynecol. 2023;229(1):72–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4753374","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343381272,"identity":"cab8775a-d842-4174-b77b-16e5fbcf0bbe","order_by":0,"name":"Yujie Chen","email":"","orcid":"","institution":"Liuzhou General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yujie","middleName":"","lastName":"Chen","suffix":""},{"id":343381275,"identity":"16833d12-001a-4e86-9946-7d7125431912","order_by":1,"name":"Xuequn Zheng","email":"","orcid":"","institution":"Liuzhou General 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23:16:05","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":201222,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Fig4.thespecimenbaglocatedbeneaththeovary.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4753374/v1/4285e4c1b4d883c8a002ce7f.jpg"},{"id":64009438,"identity":"2e1682c0-5a52-4126-ba00-1121c3600a08","added_by":"auto","created_at":"2024-09-04 23:16:06","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":650097,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Fig5.thespecimenbaglocatedbeneaththeovary2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4753374/v1/6173332a7e50800422a7cf67.jpg"},{"id":64009433,"identity":"86a63b94-4d29-43e4-8ebf-f288497c7c0c","added_by":"auto","created_at":"2024-09-04 23:16:05","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":232286,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Fig6.tumorexcisionwasperformedwithinthebag.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4753374/v1/e52f5f68c98c5b998c979b91.jpg"},{"id":64010206,"identity":"28a90bb1-15e7-4f7c-85e2-36b44a3c1d21","added_by":"auto","created_at":"2024-09-04 23:32:05","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":195817,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Fig7.specimenretrievedfromtheumbilicalincision.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4753374/v1/9d9e19fec3f902d7ebb2e774.jpg"},{"id":80887291,"identity":"5f58c268-c1bd-48ec-b6a8-3a61316709d7","added_by":"auto","created_at":"2025-04-18 09:08:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2278566,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4753374/v1/1d70e70f-b9d8-4a4c-a99f-9992d54384bf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Observation of manual Semi-isolation Specimen Bag In the process of transumbilical single port laparoscopy surgery for Benign Ovarian Tumors","fulltext":[{"header":"Background","content":"\u003cp\u003eLaparoscopic surgery is currently the main surgical approach for benign gynecological tumors\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. With the continuous advancement of surgical equipment and techniques, single-incision laparoendoscopic surgery (SILS) has emerged. SILS involves placing surgical instruments through a single incision at the umbilicus to perform the surgery, resulting in minimal trauma and better cosmetic results. It is particularly suitable for patients seeking minimal scarring, including those undergoing benign ovarian tumor resection and uterine myomas removal\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. However, single-incision laparoscopic surgery faces challenges such as the convenience of operation and tumour spillage, as well as issues like the instrument crowding, loss of triangulation, cylindrical field of view, and unstable surgical field[Uppal S, Frumovitz M, Escobar P, Ramirez PT. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol. 2011; 18(1):12\u0026ndash;23.]. In ovarian cystectomy, tumor rupture and tumor tissue leakage may occur due to the operational challenges, such as the instrument crowding and the loss of triangulation. The \" tumor-free \" principle, first proposed by Cole in 1954, has become a fundamental principle of oncologic surgery\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. It involves a series of recommendations during tumor surgery to reduce and prevent the shedding, implantation, and dissemination of tumor cells\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Here, we report a self-prepared specimen bag for single-incision laparoscopic surgery, which addresses the challenges of single-incision laparoscopic surgery by facilitating specimen retrieval and semi-isolating the operating field. In this study, we retrospectively compared the clinical outcomes, time costs, and economic costs of single-incision laparoscopic surgery and conventional multi-port laparoscopic surgery for benign ovarian tumors treated at our institution from October 2022 to October 2023.\u003c/p\u003e"},{"header":"Materials and Method","content":"\u003ch2\u003e1. Material\u003c/h2\u003e\u003cp\u003eThe self-designed specimen bag was patented in 2019 (patent number CN 211187374 U) and has been applied clinically. Ethical approval was obtained from the local ethics committee of the Liuzhou people\u0026rsquo;s Hospital, Liuzhou, Guangxi, China (KY2024-063-01), and informed consent was obtained. All protocols were conducted under the principles of the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eThe manual specimen bag was prepared as follows: it was derived from the sterile packaging bag of a disinfection pad. After removing the disinfection pad, the packaging bag is retained and kept sterile, with dimensions of approximately 16cm\u0026times;16cm. One end of the packaging bag is already closed, while the other end is folded outward by about 1-1.5cm to form a tunnel. A size 5 urinary catheter is then inserted and securely sutured to the tunnel using size 7 sutures. This creates a specimen retrieval bag that automatically expands upon use and is disposed of after single use, following medical waste disposal protocols.\u003c/p\u003e\n\u003ch3\u003e2. Method\u003c/h3\u003e\n\u003cp\u003eObservation Group: A self-designed specimen bag was utilized in conjunction with single-incision laparoscopic surgery. A 2.5cm incision was made at the umbilicus, and the skin, fat, rectus sheath, and peritoneal layers were sequentially dissected to access the abdominal cavity. An integrated puncture pathway was inserted, and pneumoperitoneum was established to facilitate comprehensive exploration of the pelvic and abdominal cavities. The specimen bag was fabricated by nursing staff as described above. The specimen bag was inserted through the puncture pathway, and it was observed that the bag could spontaneously form a circular entrance in the abdominal cavity. Adhesions in the pelvic and abdominal cavities were separated, and the specimen bag was positioned at the uterorectal pouch with its opening facing upwards. The enlarged ovaries were placed inside the specimen bag, and tumor excision was performed within the bag. Complete excision was achieved in 28 cases, with tumor rupture occurring in 12 cases during excision, all of which were collected within the specimen bag without any spillage. The specimen bag, along with the tumor, was then retrieved intact from the umbilical incision without any ruptures or spillage. The puncture pathway was re-inserted to establish pneumoperitoneum, and hemostasis and closure of ovarian tissue were performed. The abdominal cavity was cleared, and the incision was closed.\u003c/p\u003e \u003cp\u003eControl Group: Conventional multi-port laparoscopic surgery was performed. A 1cm incision was made at the umbilical circumference, and pneumoperitoneum was established using a Veress needle. Trocars were inserted through the umbilical ring, and two additional puncture points were made along the left subcostal line and the left iliac crest line (1/3 from the outer edge, 0.5-1cm in length). Ovarian tumor resection and suturing were performed using standard techniques. Specimens were placed in conventional specimen bags and retrieved through the lower left abdominal puncture hole. The abdominal cavity was cleared, and the incisions were closed.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3. Data Collection\u003c/h2\u003e \u003cp\u003eA retrospective collection of cases undergoing laparoscopic adnexal surgery at the People's Hospital of Liuzhou from October 2022 to October 2023. Preoperative assessment included detailed documentation of demographic characteristics (age, body mass index, history of pelvic surgery, type of delivery, and parity), Doppler ultrasound examination, serum CA-125 levels, and pelvic magnetic resonance imaging (when necessary). Past medical history, including previous cesarean section, appendectomy, or any pelvic surgical history, was recorded.\u003c/p\u003e \u003cp\u003eRetrieve and record the following data from electronic medical records: maximum size (in centimeters), location, intraoperative and postoperative complications of ovarian tumors, total operation time, tumor excision time, time from excision to specimen retrieval, length of hospital stay, postoperative visual analogue scale (VAS) pain scores, pain assessment, average cost, and postoperative morbidity. Total operation time is defined as the time from the first incision to the completion of closure of the last incision. Tumor excision time refers to the time from incision of the tumor capsule to complete excision of the tumor. The time from completion of tumor excision to complete retrieval of the specimen from the incision site is defined as the time from excision to specimen retrieval. Hospital stay is defined as the number of hours hospitalized after surgery. VAS scores are obtained at 12 hours and 24 hours postoperatively (with 1 indicating mild pain and 10 indicating severe pain). There is currently no authoritative definition for postoperative morbidity; typically, it refers to having a body temperature of 38\u0026deg;C or higher measured at least twice daily from the day after surgery until discharge.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e4. Statistics\u003c/h2\u003e \u003cp\u003eSPSS 20.0 software was used for data analysis. Continuous data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), and Student\u0026rsquo;s t-test was used for comparison. Categorical data were expressed as percentages, and the chi-square test was used for comparison. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cp\u003eA total of 75 patients were included in the final analysis, and demographic characteristics and baseline features were similar between the two groups. All patients underwent successful laparoscopic surgery without excessive intraoperative bleeding requiring transfusion (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe maximum diameters of tumors in the two groups were 11.5 cm (4.8 cm-11.5 cm) and 11 cm (4.5 cm-11 cm), respectively, with average sizes being similar (73.57\u0026thinsp;\u0026plusmn;\u0026thinsp;18.34 cm vs. 77.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.36 cm, P\u0026thinsp;=\u0026thinsp;0.393). The majority of tumors were benign, with teratomas accounting for 57.14% (20/35) and 65.00% (26/40) in each group, respectively. Serous cyst adenomas accounted for 25.71% (9/35) and 17.50% (7/40), mucinous cystadenomas accounted for 8.57% (3/35) and 10.00% (4/40), other benign types accounted for 5.71% (2/35) and 5.00% (2/40), and borderline tumors accounted for 2.86% (1/35) and 2.50% (1/40), respectively. The average total operation time was similar (101.54\u0026thinsp;\u0026plusmn;\u0026thinsp;32.16 min vs. 101.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.46 min, P\u0026thinsp;=\u0026thinsp;0.964). In the traditional multi-port laparoscopic surgery group, tumor excision time was shorter than in the single-incision surgery group (42.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77 min vs. 51.88\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06 min, P\u0026thinsp;=\u0026thinsp;0.002). However, in the specimen retrieval phase, the manual specimen bag in the single-incision laparoscopic surgery group facilitated complete retrieval of specimens, and it took less time (25.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40 min vs. 36.66\u0026thinsp;\u0026plusmn;\u0026thinsp;15.12 min, P\u0026thinsp;=\u0026thinsp;0.000). During tumor excision, the majority of specimens were completely contained within the specimen bag without tissue leakage. Postoperative examination using a \"leakage test\" or \"inflation test\" confirmed the integrity of the specimen bag.\u003c/p\u003e \u003cp\u003eThere were no serious postoperative complications in either group. In the observation group, 2 cases (5.0%) of patients experienced redness and slight exudation at the abdominal incision site postoperatively, which improved after local wound care reinforcement, without requiring re-suturing for poor wound healing (Grade II). Both groups of patients did not require postoperative analgesic pumps, and pain (VAS) scores ranged from 3 to 5 (4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6 vs. 3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3, P\u0026thinsp;=\u0026thinsp;0.881). There was no statistically significant difference in postoperative morbidity between the two groups, but no cases occurred in the observation group meanwhile 2 in the control group.\u003c/p\u003e \u003cp\u003e(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe specimen bag used in the observation group only required a disposable urinary catheter, costing 2.6 RMB, while the commercial price of specimen bags ranged from 100 to 350 RMB\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral preoperative data in both groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Group(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.66\u0026thinsp;\u0026plusmn;\u0026thinsp;14.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.66\u0026thinsp;\u0026plusmn;\u0026thinsp;14.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/㎡)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.24\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.902\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ehistory of previous pelvic and abdominal surgery (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.975\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe comparison of the intraoperative and postoperative conditions between the two groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl Group(n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Group(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage ovarian tumor size(cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.57\u0026thinsp;\u0026plusmn;\u0026thinsp;18.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.23\u0026thinsp;\u0026plusmn;\u0026thinsp;18.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eteratomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.14% (20/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.00% (26/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerous cyst adenomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.71% (9/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.50% (7/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emucinous cystadenomas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.57% (3/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.00% (4/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eother benign types\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.71% (2/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.00% (2/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eborderline tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.86% (1/35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.50% (1/40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etotal operative time( min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101.54\u0026thinsp;\u0026plusmn;\u0026thinsp;32.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etumor excision time(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.88\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003etime of specimen removal after tumor excision(min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.66\u0026thinsp;\u0026plusmn;\u0026thinsp;15.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003elength of stay(天)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.55\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epostoperative morbidity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSingle-port laparoscopy, as an advanced minimally invasive technique developed in recent years, offers advantages such as minimal trauma, reduced postoperative pain, and faster recovery\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Additionally, the single-port incision typically ranges from 2.5 to 3 cm, allowing for easier and more complete specimen retrieval, particularly for solid components within ovarian tumors, such as skin, hair, and bony elements, which are less easily dissected tissues. This facilitates specimen retrieval through the umbilical incision, effectively saving surgical time. Single-port laparoscopic surgery presents specific challenges compared to traditional multi-port laparoscopic surgery, primarily related to maintaining pneumoperitoneum, adequate traction for exposure, instrument collisions, collisions between instruments and the camera, and limited maneuverability, necessitating a considerable learning curve for beginners\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. In patients undergoing single-port laparoscopic ovarian tumor resection, the proportion of cyst rupture due to inexperienced operators may be slightly higher than in traditional laparoscopic surgery.\u003c/p\u003e \u003cp\u003eOvarian tumors are common tumors of the female reproductive organs. Due to their anatomical structure being relatively isolated from vital organs and structures, they have become one of the diseases early applied in single-port laparoscopy. Pathologically, benign ovarian tumors exhibit diverse types, with common pathological types including ovarian endometrioma, mature teratoma, serous cystadenoma, and mucinous cystadenoma. Ovarian endometrioma is characterized by invasive growth and a tendency for recurrence, while mucinous cystadenoma exhibits characteristics of implantation metastasis and recurrence. Improper intraoperative handling of these two types of benign ovarian tumors may lead to postoperative recurrence. Mature teratomas of the ovary typically contain abundant hair and adipose tissue, and improper intraoperative handling may lead to pelvic adhesions postoperatively. Before pathological confirmation, the possibility of malignant tumors cannot be completely ruled out\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. In our clinical data, mature teratoma is the most common type of ovarian tumor encountered during laparoscopic surgery. Despite thorough preoperative assessments, borderline ovarian tumors discovered intraoperatively still account for a certain proportion. Therefore, tumor isolation should not be limited to the specimen retrieval phase but should extend throughout the entire surgical process. These challenges highlight the need to address the \"no tumor left behind\" principle during surgery.\u003c/p\u003e \u003cp\u003eKisu et al. reported the use of the Alexis Contained Extraction System for specimen collection in laparoscopic surgery, which allows for complete abdominal isolation during specimen retrieval, with a market price of approximately \u003cspan\u003e$\u003c/span\u003e40\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Bao Huiqiong et al. reported the use of the TKBAG minimally invasive surgical tissue extraction device, which is inserted through the umbilicus for tissue separation and retrieval within the bag, with a market price of around 500 RMB\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Some articles have reported the use of latex gloves as specimen retrieval bags during surgery\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. However, latex gloves havea certain degree of elastic recoil and may not maintain sufficient tension within the abdominal cavity to provide effective isolation. In this study, we propose a semi-isolation specimen bag marked with an opening, which is easy to unfold under laparoscopy. With a diameter of approximately 12 cm and a depth of around 12 cm, it can be used for surgeries involving ovarian tumors of about 10 cm in size. Under single-port laparoscopic surgery, pulling the opening can easily support and fix the bag under the tumor, and after tumor excision, the bag mouth can be easily gathered for retrieval. Our data show that although the tumor excision time is longer than that of traditional multi-port laparoscopic surgery, the time for specimen retrieval after tumor excision is significantly shortened when using the single-port laparoscopic approach combined with the specimen bag. Moreover, the overall duration of surgery is not prolonged. The use of this manual specimen bag significantly reduces tissue leakage, maintains a clean surgical field, and shortens the time required for rinsing the abdominal cavity, leading to a lower postoperative morbidity rate observed in our cases.\u003c/p\u003e \u003cp\u003eBased on our practice, we summarize the advantages of the manual semi-isolation specimen retrieval bag under single-port laparoscopy as follows: 1. Combining the semi-isolation specimen retrieval bag with single-port laparoscopic surgery allows for intraoperative isolation of the surgical field before tumor dissection, enabling direct retrieval into the bag even if the tumor ruptures, with no cases of bag rupture observed. This reduces tissue fragmentation and fully embodies the principle of no tumor left behind; 2. Practicality: Easy to learn and use, conducive to promotion, with minimal additional cost of consumables, suitable for implementation in grassroots hospitals; 3. Aesthetic appeal: Fully utilizes the aesthetic advantages of single-port laparoscopy and minimally invasive techniques, without the need for additional access channels; 4. The use of this isolation bag reduces the tension of the operating physician, facilitates the training of young physicians, and effectively shortens the learning curve for single-port laparoscopy.\u003c/p\u003e \u003cp\u003eThe combination of single-port laparoscopy with this manual specimen bag shows promising applications and effective tumor defense for benign ovarian tumors\u0026thinsp;\u0026lt;\u0026thinsp;12 cm in size. However, accommodating and extracting large specimens remains a major challenge.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthical approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe authors are accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki(as revised in 2013). The research design was approved by the Ethics Committee (No. Lunshen-2011-KY-2022-063-01; April 7,2011).All patients provided written informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has been approved by the Ethics Committee of Liuzhou People\u0026apos;s Hospital. All participants have provided informed consent for the scientific use of medical data.\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch3\u003eData availability\u003c/h3\u003e\n\u003cp\u003eThe dataset generated and/or analyzed in this study can be obtained from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003ch3\u003eConflicts of interest\u003c/h3\u003e\n\u003cp\u003eThe authors have no potential conflicts of interest to report.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eGuangxi Science and Technology Plan Project (Guangxi Clinical Research Center for Obstetrics and Gynecology，GuiKe AD22035223）\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026apos; contributions\u003c/h3\u003e\n\u003cp\u003eYujie Chen and Wenjuan Yi wrote the main manuscript text, Xuequn Zheng, Liju Huang, and Lifeng Lan prepared figures, and Daidong Yuan took photos. Fei Yu conducted the statistical analysis, and all authors reviewed the manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgement\u003c/h3\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to the data belonging to the hospital database, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the local ethics committee of the Liuzhou people\u0026rsquo;s Hospital , Liuzhou, Guangxi, China (KY2024-063-01), and informed consent was obtained. All protocols were conducted under the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were determined as follows; age between 18 and 55 years, body mass index (BMI) 18\u0026ndash;40 kg /m2 , and the presence of a .\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVan Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JM. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev. 2019;8(8):CD012858.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUppal S, Frumovitz M, Escobar P, Ramirez PT. Laparoendoscopic single-site surgery in gynecology: review of literature and available technology. J Minim Invasive Gynecol. 2011;18(1):12\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtkin G, Chopada A, Mitchell I. Colorectal cancer metastasis: in the surgeon's hands? Int Semin Surg Oncol. 2005;2(1):5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStentz NC, Cooney LG, Sammel M, et al. Changes in Myomectomy Practice After the U.S. Food and Drug Administration Safety Communication on Power Morcellation. Obstet Gynecol. 2017;129(6):1007\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeshmukh CS, Ganpule AP, Islam MR, et al. Laparoscopic and robotic specimen retrieval system (Modified Nadiad Bag): Validation and cost-effectiveness study model. J Minim Access Surg. 2019;15(4):305\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilani R. Comparing self-assessment of laparoscopic technical skills with expert opinion for gynecological surgeons in an operative setting. Gynecol Surg. 2018;15(1):16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoruta DM. Laparoendoscopic single-site surgery in gynecologic oncology: An update. Gynecol Oncol. 2016;141(3):616\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNan ZHANG, Wen DI. Tumor-free principle in surgery for benignovarian tumors. Chin J Practical Gynecol Obstet. 2023;39(1):25\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKisu I, Banno K, Tokuoka A, et al. Technique for transvaginal removal of large specimen using an Alexis Contained Extraction System during laparoscopic hysterectomy. Obstet Gynecol Sci. 2022;65(3):283\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBao H, Xun D. Application of transumbilical specimen retrieval technique in laparoscopic myomectomy. J Practical Obstet Gynecol. 2020;36(6):475\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eG\u0026uuml;ven CM. Uysal. In-bag abdominal manual morcellation versus contained power morcellation in laparoscopic myomectomy: a comparison of surgical outcomes and costs. BMC Surg. 2023;23(1):106.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan P, Shan L, Yang X, et al. The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy. Am J Obstet Gynecol. 2023;229(1):72\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Transumbilical single port laparoscopy surgery, Semi-isolation, Specimen retrieval, Leakage༛Benign ovarian tumors","lastPublishedDoi":"10.21203/rs.3.rs-4753374/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4753374/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe aim of this study was to demonstrate a manual semi-isolation specimen bag, and to compare the spillage rate and surgical outcomes between the usage this specimen bag in the process of transumbilical single-port laparoscopy and the conventional technique in laparoscopy for ovarian tumors (less than 12 cm in diameter) presumed to be benign.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective analysis was conducted on 75 patients who underwent laparoscopic resection of ovarian tumors at the People's Hospital of Liuzhou, Guangxi, China, from October 2022 to October 2023. Among them, 40 cases were treated with transumbilical single-port laparoscopy combined with the manual semi-isolation specimen bag (study group), and 35 cases were treated with traditional multi-port laparoscopy (control group). The average total operation time, tumor resection time, time for specimen retrieval after tumor resection, and postoperative recovery were observed in both groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe two groups had similar baseline characteristics. The tumor excision time of control group was shorter than in the study group (42.46\u0026thinsp;\u0026plusmn;\u0026thinsp;12.77 min vs. 51.88\u0026thinsp;\u0026plusmn;\u0026thinsp;13.06 min). but the time of specimen removal after tumor excision were significantly shorter in the study group compared to those in the control group(25.98\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40 min vs. 36.66\u0026thinsp;\u0026plusmn;\u0026thinsp;15.12 min).However, the average total operation time was similar (101.54\u0026thinsp;\u0026plusmn;\u0026thinsp;32.16 min vs. 101.28\u0026thinsp;\u0026plusmn;\u0026thinsp;18.46 min༉. Other surgical outcomes, which were similar between two groups, included length of hospital stay and VAS score at 12h postoperatively. There were no postoperative morbidity in the study group meanwhile 2 in the control group.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe use of the manual semi-isolation specimen bag in the process of\u003c/p\u003e","manuscriptTitle":"Clinical Observation of manual Semi-isolation Specimen Bag In the process of transumbilical single port laparoscopy surgery for Benign Ovarian Tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-04 23:16:00","doi":"10.21203/rs.3.rs-4753374/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"299721f8-a216-4dff-9626-417104b07b4d","owner":[],"postedDate":"September 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-18T09:08:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-04 23:16:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4753374","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4753374","identity":"rs-4753374","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}