Can In-Bag Manual Morcellation Represent an Alternative to Uncontained Power Morcellation in Laparoscopic Myomectomy? A Randomized Controlled Trial

Aims: The study aimed to evaluate feasibility and safety of in-bag manual morcellation compared to uncontained power morcellation during laparoscopic myomectomy. Methods: A total of 72 women undergoing laparoscopic myomectomy were randomized into 2 treatment groups: 34 patients underwent in-bag manual morcellation (experimental group) and 38 were submitted to uncontained power morcellation (control group). The primary end point was the comparison of morcellation operative time (MOT). Total operative time (TOT), rate of intraoperative complication, and postoperative outcomes in the 2 groups were regarded as secondary outcomes. Results: Mean MOT and TOT were longer in the experimental group than in the control one (MOT: 9.47 ± 5.05 vs. 6.16 ± 7.73 min; p = 0.01; TOT: 113.24 ± 28.12 vs. 96.74 ± 33.51 min; p = 0.01). No intraoperative complications occurred in either group and no cases of bag disruption or laparotomic conversion were recorded. No significant difference in hemoglobin drop, hospital stay, and postoperative outcomes was reported between groups. Conclusion: In-bag manual morcellation appears a safe and feasible procedure and, despite slightly longer operative time, could represent an alternative to uncontained power morcellation

The Role of Pelvic Ultrasound in Preoperative Evaluation for Laparoscopic Myomectomy

Study Objective: To determine the accuracy of pelvic ultrasonography (US) in preoperative evaluation before laparoscopic myomectomy. Design: A prospective cohort study (Canadian Task Force classification II-2). Setting: A tertiary level referral center of minimally invasive gynecologic surgery, Sant'Orsola University Hospital, Bologna, Italy. Patients: One hundred one of the 125 women undergoing laparoscopic myomectomy from September 2015 to May 2016 were included. Interventions: Preoperative pelvic US was performed 2 weeks before surgery. Measurements and Main Results: Among the 101 women enrolled in this study, preoperative US correctly identified the number of myomas in 73 patients (72.3%). A total of 208 myomas were preoperatively identified by US; 197 (94.7%) were surgically removed, and 11 (5.3%) were not visualized during laparoscopic myomectomy. The 11 undetected myomas were intramural (International Federation of Gynecology and Obstetrics [FIGO] type 3 and 4), with a mean diameter of 19.05 ± 5.91 mm. The type, site, and location of the 197 myomas identified by US preoperatively and removed via laparoscopy were confirmed at surgery in 78.7% (155/197), 80.7% (159/197), and 84.3% (166/197) of the cases, respectively. Two-hundred fifty-four total myomas were removed laparoscopically; 197 (77.6%) were preoperatively identified by US, and 57 (22.4%) were missed by US, having had a mean diameter of 13.51 ± 7.84 mm and predominantly being the subserosal type (FIGO type 5, 6, and 7) (57.9%, p < .05). Conclusion: Pelvic US is a valuable tool in preoperative evaluation and should be systematically performed when planning laparoscopic myomectomy