Obstet Gynecol Sci.  2022 May;65(3):283-285. 10.5468/ogs.21358.

Technique for transvaginal removal of large specimen using an Alexis Contained Extraction System during laparoscopic hysterectomy

Affiliations
  • 1Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
  • 2Keio University School of Medicine, Tokyo, Japan

Abstract


Objective
Transvaginal removal of large specimens during laparoscopic hysterectomy can be a complex surgical procedure that poses a risk of organ injury and tissue spillage into the abdominal cavity and is associated with extraction of the specimen and manual morcellation. Our objective was to demonstrate a technique for transvaginal removal of large specimens using the Alexis Contained Extraction System (CES) in laparoscopic hysterectomy.
Methods
The technique used for transvaginal removal of large specimens using the Alexis CES was presented in this video. Surgery was performed at a tertiary hospital.
Results
Following resection of the specimen during laparoscopic hysterectomy, the Alexis CES was inserted into the abdominal cavity through the umbilical trocar wound. The specimen was placed in a bag to prevent tissue spillage. The ring retractor was guided to the vagina and pulled out transvaginally. By repeatedly turning the ring retractor, tension was applied to the specimen bag, and the vaginal wall was unfolded all around to enable a secure surgical field. During manual morcellation of the specimen in the bag, the retractor was pulled and additionally turned to roll and re-tension the specimen bag when the bag was loosened. The specimen was pushed out of the vagina and safely and effectively extracted without concerns about tissue spillage in the abdominal cavity or related organ injuries.
Conclusion
The technique for transvaginal removal of large specimens using the Alexis CES enables simple, effective, and safe tissue extraction with contained manual morcellation during laparoscopic hysterectomy.

Keyword

Morcellation; Laparoscopy; Hysterectomy

Figure

  • Fig. 1 Transvaginal removal of the specimen using the Alexis Contained Extraction System (CES) during laparoscopic hysterectomy. The Alexis CES enables effective and safe tissue specimen extraction by maintaining a secure surgical field and applying tension to the specimen bag.


Reference

References

1. Moawad GN, Tyan P, Awad C. Technique for tissue containment and extraction in the complex minimally invasive myomectomy setting. J Minim Invasive Gynecol. 2019; 26:809–10.
Article
2. Vargas MV, Moawad GN, Sievers C, Opoku-Anane J, Marfori CQ, Tyan P, et al. Feasibility, safety, and prediction of complications for minimally invasive myomectomy in women with large and numerous myomata. J Minim Invasive Gynecol. 2017; 24:315–22.
Article
3. Hong DH, Kim M, Kim K, Suh DH, No JH, Kim YB. Use of a ring retractor to facilitate specimen removal in laparoscopic surgery. Obstet Gynecol Sci. 2020; 63:548–9.
Article
4. Stentz NC, Cooney LG, Sammel M, Shah DK. Changes in myomectomy practice after the U.S. food and drug administration safety communication on power morcellation. Obstet Gynecol. 2017; 129:1007–13.
Article
5. Zapardiel I, Boria F, Halaska MJ, De Santiago J. Laparoscopic power morcellation: techniques to avoid tumoral spread. J Minim Invasive Gynecol. 2021; 28:1442–3.
Article
6. Siedhoff MT, Doll KM, Clarke-Pearson DL, Rutstein SE. Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications. Am J Obstet Gynecol. 2017; 216:259e1–6.
Article
7. Arenal JJ, Martínez A, Maderuelo MV, Tinoco C, Benito C, Citores MA, et al. Reduced wound infection in colorectal resection by using a wound auto-retractor. Infez Med. 2016; 24:310–7.
8. Cheng KP, Roslani AC, Sehha N, Kueh JH, Law CW, Chong HY, et al. ALEXIS O-Ring wound retractor vs conventional wound protection for the prevention of surgical site infections in colorectal resections(1). Colorectal Dis. 2012; 14:e346–51.
Article
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