Vaginal Tissue Extraction Made Easy

Study Objective To demonstrate a new technique to improve vaginal morcellation. Design This video demonstrates a step-by-step process for morcellation through the vagina in a contained environment (Canadian Task Force Classification III). Setting When performing laparoscopic hysterectomy, difficulty arises when the tissue being extracted is larger than the incision made. To avoid extending an abdominal incision, the colpotomy tends to be the favorable location for removal. The difficulty with vaginal morcellation lies in retraction and keeping the specimen at the colpotomy site. Intervention This 42-year-old gravida 0 female with abnormal uterine bleeding with leiomyoma had completed child-bearing and desired a hysterectomy. She had a 17-week sized uterus with enlarged bulky myomas. Total laparoscopic hysterectomy was performed using three 5-mm ports. After the hysterectomy completed, the specimen was placed in a bag for removal. Morcellation was performed, and the specimen was removed. This video demonstrates a simple technique for containing the specimen using a bag, an Alexis ring, and a stapler, and then removing it vaginally. This approach provides vaginal protection and retraction in a contained system. It also eliminates the need to close the abdominal fascia. Conclusion Morcellation performed through the vagina can be quick and easy using the technique shown in this video. Not only does the technique provide vaginal protection and retraction, but it also contains the specimen to prevent its loss during the morcellation process and to avoid the spread of any unforeseen malignancy. By eliminating the need to close the abdominal fascia, surgical time is reduced, and concerns about hernia formation from extended incisions are allayed.