In Bag Morcellation

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Video Description

This video demonstrates a step-wise approach to in bag mechanical morcellation.

Presented By

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Dr. Sukhbir Sony Singh


University of Ottawa, The Ottawa Hospital

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Video Transcript: In Bag Morcellation

This video will describe a stepwise approach of In Bag Mechanical Morcellation that can be performed either abdominally or vaginally. 

The technique is probably divided into five major steps.

  • Step One: Introduction and retrieval of the bag into the abdomen.
  • Step Two: Placement of the specimen inside the bag.
  • Step Three: Bring out the bag containing the specimen.
  • Step Four: Performing the mechanical morcellation and delivering the specimen.
  • Step Five: Check the integrity of the bag at the end of the procedure.

Vaginal morcellation is accomplished using the colpotomy created during the laparoscopic hysterectomy.

To introduce the bag, an eight by ten inch LapSac by Cook Medical is folded in an accordion fashion. This is placed in the vaginal obturator with open ends and thread facing up.

The vaginal obturator is then placed through the colpotomy, and the bag is retrieved into the abdomen by pulling on the threads using a grasper.

The bag is unfolded, and the specimen is placed inside. Larger size bags can be used for bigger specimens. 

After ensuring that the whole specimen is placed inside, the opening can be sealed by pulling on the thread. To bring out the opening of the bag through the vagina, the thread is fitted to the obturator, and the ends are retrieved by pulling on the thread. 

A small self-retaining ring retractor is placed and the ends of the bag are rolled over it. Retractors are placed, and a tenaculum is applied to the specimen for traction. 

Morcellation of the specimen is then performed by mechanical coring using a scalpel until the specimen is small enough to deliver through the colpotomy. 

Visual inspection of the bag to look for any inadvertent tears should be done at the end. 

Morcellation, when performed abdominally, is accomplished by extending the umbilical incision. 

For the introduction, the same bag is tightly rolled over the introducer. 

The camera is then transferred on a five millimetre scope. And the bag on the introducer is pushed through the ten millimetre umbilical port as far as possible.

With the help of the grasper, the bag is stabilized and unrolled inside the abdomen.

This is followed by the placement of the specimen inside the bag. 

To bring out the opening of the bag, the umbilical incision is extended up to two to three centimetres, and the ends are pulled out. 

A small self-retaining ring retractor is then placed and is rolled over the edges of the bag. This optimizes the visualization of the specimen inside the bag.

Mechanical morcellation of the specimen is performed in a similar fashion.

At the end of the procedure, the integrity of the bag should be checked. This can be done by looking for any leaks due to inadvertent tears.