Laparoscopic tissue fragmentation under visual control: Concept and experimental experience

Abstract

The extraction of resected tissue is a specific problem of advanced endoscopic procedures in different fields of minimally invasive therapy. The retrieval of parenchymatous organs like the kidney or the spleen requires either laparotomy or intracorporeal morcellation. Most of the current morcellation techniques result in uncontrolled fragmentation or liquidization of the organ. The post-operative pathologic work-up is therefore severely limited. Our concept of organ fragmentation and retrieval is based on a large bag which we called TRIPORTBAG (three port bag) with two supplemental access tubes. After organ entrapment the three access points are withdrawn from the abdominal cavity. An endoscope and specific instruments can be introduced into the bag. Tissue fragmentation is carried out under continuous video imaging and recording. The fragmentation can be performed with various tools, e.g. scissors of HF-electrodes. This procedure allows selective intracorporeal work-up of the pathologic organ similar to the way it is normally done by the pathologist. Due to application of a 20 mm trocar as main access to the bag, a relatively large fragment size can be achieved. Video recording allows post-operative assignment of the fragments to the original shape of the specimen. The bags we used are currently prototypes. The technique was tested in phantom and animal experiments; before clinical application complete water- and gas-tightness of the cloth bag (Aramide) must be guaranteed.

Key Words:

• laparoscopic surgery
• morcellation
• tissue fragmentation
• tissue retrieval bag