Vaginal morcellation: A new strategy for large gynecological malignant tumor extraction A pilot study


Autoria(s): Favero, Giovanni; Anton, Cristina; Silva e Silva, Alexandre; Ribeiro, Altamiro; Araujo, Marcia Pereira; Miglino, Giovanni; Baracat, Edmund Chada; Carvalho, Jesus Paula
Contribuinte(s)

UNIVERSIDADE DE SÃO PAULO

Data(s)

21/10/2013

21/10/2013

2012

Resumo

Objective. Evaluate feasibility and safety of a novel technique for uterine morcellation in patients scheduled for laparoscopic treatment of gynecologic malignances. Background. The laparoscopic management of uterine malignancies is progressively gaining importance and popularity over laparotomy. Nevertheless, minimal invasive surgery is of limited use when patients have enlarged uterus or narrow vagina. In these cases, conventional uterus morcellation could be a solution but should not be recommended due to risks of tumor dissemination. Methods. Prospective pilot study of women with endometrial cancer in which uterus removal was a realistic concern due to both organ size and proportionality. Brief technique description: after completion of total laparoscopic hysterectomy and bilateral anexectomy, a nylon with polyurethane Lapsac (R) is vaginally inserted into the abdomen; the specimen is placed inside the pouch that will be closed and rotated 180 degrees toward the vaginal vault and, posteriorly, pushed into the vaginal canal; in the transvaginal phase, the surgeon pulls the edges of the bag up to vaginal introitus and all vaginal walls will be covered; inside the pouch, the operator performs a uterus bisection-morcellation. Results. In our series of 8 cases, we achieved successful completion in all patients, without conversion to laparotomy. Average operative time, blood loss and length of hospitalization were favorable. One patient presented with a vesicovaginal fistula. Conclusion. The vaginal morcellation following oncologic principles is a feasible method that permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies. Further studies are needed to confirm the oncological safety of the technique. (C) 2012 Elsevier Inc. All rights reserved.

Identificador

GYNECOLOGIC ONCOLOGY, SAN DIEGO, v. 126, n. 3, supl. 1, Part 4, pp. 443-447, SEP, 2012

0090-8258

http://www.producao.usp.br/handle/BDPI/35372

10.1016/j.ygyno.2012.05.023

http://dx.doi.org/10.1016/j.ygyno.2012.05.023

Idioma(s)

eng

Publicador

ACADEMIC PRESS INC ELSEVIER SCIENCE

SAN DIEGO

Relação

GYNECOLOGIC ONCOLOGY

Direitos

closedAccess

Copyright ACADEMIC PRESS INC ELSEVIER SCIENCE

Palavras-Chave #VAGINAL MORCELLATION #UTERINE MALIGNANCIES #LAPAROSCOPY #SURGICAL POUCH #ENDOMETRIAL STROMAL SARCOMA #UTERINE MORCELLATION #HYSTERECTOMY #CANCER #UTERUS #HYPERPLASIA #SURGERY #RISK #ONCOLOGY #OBSTETRICS & GYNECOLOGY
Tipo

article

original article

publishedVersion