Uncontained compared with contained power morcellation in total laparoscopic hysterectomy

OBJECTIVE: To compare perioperative outcomes of uncontained and contained power morcellation in total laparoscopic hysterectomy. METHODS: Women who underwent total laparoscopic hysterectomy that required utilization of power morcellation between July 2012 and January 2015 in the Division of Minimally Invasive Gynecology at an academic tertiary care center were included. In February 2014, the division began performing all power morcellation contained within a large insufflated bag in an attempt to reduce dissemination of benign and malignant uterine tissue. Data were collected from a prospective database and analyzed as a retrospective cohort. The primary outcome was operative time. Secondary outcomes included estimated blood loss, length of stay, pathology, uterine weight, and complications, including blood transfusion, conversion to open, intraoperative organ injury, pelvic infection, readmission, or reoperation. RESULTS: A total of 152 patients were identified: 101 uncontained morcellations and 51 contained morcellations. The baseline demographic characteristics between the two groups were similar. Operative time was longer in the contained morcellation group (184 compared with 164 minutes, P=.01). There were no cases of visible bag disruption or dissemination of uterine tissue in the contained morcellation group. CONCLUSION: Contained power morcellation at the time of total laparoscopic hysterectomy is associated with a 20-minute increase in operative time when compared with uncontained morcellation.