Bag Exteriorization and Draping

The drawstring and then the edges of the LapSac are withdrawn through the skin. If desired, the skin as well as the underlying fascia can be incised to increase access to the specimen within the bag. Expansion to 2-3 cm permits easier morcellation and extraction of larger fragments; however, the port site then necessitates closure. We meticulously drape around the exteriorized bag, minimizing skin exposure and potentially reducing the likelihood of tumor seeding. The skin is covered using polyethylene filme and a second layer of surgical towels is clipped around the LapSac. Several surgical clamps are securely fixed to the edges of the bag to provide upward traction.

e3M Health Care, St. Paul, MN.

Principles during the morcellation process:

■ CO2 insufflation is continued to maintain pneumoperitoneum, increasing the intra-abdominal space and distance of the specimen/bag from adjacent structures. This may help prevent injury to nearby organs and vessels.

■ Morcellation should be carried out under direct laparoscopic vision.

■ After complete specimen removal, the instruments used for morcella-tion are isolated, the drapes around the port are removed, and surgical gowns and gloves are changed prior to fascia/skin closure.

None of the currently available devices to facilitate morcellation is ideal and all should be used cautiously in clinical situations.

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