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Laparoscopic subtotal hysterectomy followed by in-bag transvaginal corpus uteri morcellation and extraction: A case series

Published:January 17, 2023DOI:https://doi.org/10.1016/j.ejogrb.2023.01.015

      Highlights

      • Specimen retrieval is a challenging step of laparoscopic subtotal hysterectomy (LSH).
      • Unsuspected malignancy could be spread intrabdominally at the time of morcellation.
      • Morcellation inside a purpose-built bag (contained) preserves oncological safety.
      • Specimen extraction through the posterior vaginal fornix is a reliable procedure.
      • Transvaginal contained uterus morcellation and extraction is feasible and safe in LSH.

      Abstract

      Objectives

      Laparoscopic subtotal hysterectomy (LSH) is a possible treatment for patients with benign uterine disease. Once the hysterectomy has been completed, morcellation and extraction of the corpus uteri is a crucial step of the procedure. We here present a case series to evaluate the feasibility of the in-bag transvaginal specimen retrieval following LSH.

      Study design

      We report a case series of consecutive patients who underwent LSH followed by in-bag transvaginal specimen retrieval. LSH was accomplished in a standard fashion. Once the uterus was detached from the cervix, a 2 cm posterior colpotomy was performed laparoscopically with a monopolar hook under direct view to insert a specimen retrieval bag into the abdomen. The corpus uteri was placed into the bag and transvaginal contained manual morcellation was performed. The colpotomy was then sutured transvaginally. Baseline patients’ characteristics and surgical data were collected. Postoperative complications, same-hospital readmissions, and reoperations were registered if occurred within 30 days from surgery.

      Results

      Patients’ median age and BMI were 45,5 and 22,7, respectively. Median operative time was 71.5 min (range 34–143) and uterus weight ranged from 60 g to 470 g (median 210 g). The estimated blood loss was 100 mL (median) and no blood transfusion was required. No conversions to open surgery, nor intraoperative complications occurred. Median hospital stay was 2 days (1–3) and no postoperative complications within 30 days from surgery were recorded.

      Conclusions

      LSH followed by in-bag transvaginal specimen extraction is a promising technique and might be considered a reliable and safe option to further reduce the invasiveness of the procedure.

      Keywords

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