Prospective Evaluation of Manual Morcellation Techniques: Minilaparotomy versus Vaginal Approach.

Abstract

STUDY OBJECTIVE\nTo compare the number of days required to return to daily activities after laparoscopic hysterectomy with 2 tissue extraction methods: manual morcellation via colpotomy or minilaparotomy. Secondary outcomes were additional measures of patient recovery, perioperative outcomes, containment bag integrity, and tissue spillage.\n\n\nDESIGN\nMulticenter prospective cohort study and follow-up survey (Canadian Task Force classification II-2).\n\n\nSETTING\nTwo tertiary care academic centers in northeastern United States.\n\n\nPATIENTS\nSeventy women undergoing laparoscopic hysterectomy with anticipated need for manual morcellation.\n\n\nINTERVENTIONS\nTissue extraction by either contained minilaparotomy or contained vaginal extraction method, along with patient-completed recovery diary.\n\n\nMEASUREMENTS AND MAIN RESULTS\nRecovery diaries were returned by 85.3% of participants. There were no significant differences found in terms of average pain at 1, 2, or 3 weeks after surgery or in time to return to normal activities. Patients in both groups used narcotic pain medication for an average of 3 days. After adjusting for patient body mass index, history of prior surgery, uterine weight, and surgeon, there were no differences found for blood loss, operative time, length of stay, or incidence of any intra- or postoperative complication between groups. All patients had benign findings on final pathology. More cases in the vaginal contained extraction group were noted to have bag leakage on postprocedure testing (13 [40.6%] vs 3 [8.3%] tears in vaginal and minilaparotomy groups, respectively; p\u202f=\u202f.003).\n\n\nCONCLUSION\nRegarding route of tissue extraction, contained minilaparotomy and contained vaginal extraction methods are associated with similar patient outcomes and recovery characteristics.