Preventing organ injury and dissemination of an occult malignancy and benign gynecologic disease during vaginal morcellation with a large uterus in laparoscopic hysterectomy.

Abstract

  Following expansion of the surgical indications for laparoscopic surgery, even a large uterus can be removed via laparoscopic hysterectomy. Morcellation involves fragmentation of the uterus into smaller pieces for easier specimen extraction. However, morcellation may cause iatrogenic complications associated with intra-abdominal fragmentation and dissemination of an occult malignancy and benign gynecological disease. Vaginal morcellation is associated with the risk of vaginal injury, as well as injury to the surrounding viscera. We investigated the role of the Alexis Contained Extraction System for vaginal morcellation and removal of a large uterus. This device minimizes the risk of visceral injury and prevents dissemination of potentially malignant tissue and benign gynecological disease. The Alexis Contained Extraction System is particularly useful in patients in whom optimal exposure of the surgical field is challenging, such as in women with a narrow vaginal vault, in those with vaginal wall relaxation, and in patients with a high body mass index. This device reduces the risk of vaginal lacerations, tears, and bruising caused by sharp-edged retractors. We conclude that the Alexis Contained Extraction System is useful during laparoscopic hysterectomy for safe vaginal morcellation and removal of a large uterus.