Background: Intra-abdominal masses are removed during laparoscopy using different types of endobags. However, in many cases the specimens are larger than the trocar or the incision in the abdomen, with a potential risk of endobag rupture.
Instrument: We developed an instrument to facilitate extraction of an endobag during laparoscopy without the need for a conventional minilaparotomy. The endobag extractor has three removable diverging blades that symmetrically enlarge the operative canal in the abdominal wall if spread after sharp extension of the skin incision. The full endobag can be drawn through the canal without the risk of endobag rupture because the size of the canal can be individualized, building a funnel.
Experience: We removed various kinds of ovarian tumors, specimens from salpingo-oophorectomies, and other specimens in 22 cases.
Conclusion: This new instrument allows easy removal of surgical specimens during laparoscopy without conventional minilaparotomy, regardless of the type of endobag used. We believe this instrument lessens the risk of endobag rupture.
Endobags are used to remove intra-abdominal masses such as ovarian tumors, uterine myomas, ovaries, fallopian tubes, appendices, extrauterine pregnancies, or lymph nodes during laparoscopy.1,2 However, it is often difficult to extract the endobag through a 10- or 12-mm cannula because the tumors or specimens are often larger than the cannula or the incision in the abdomen after removal of the instrument, creating a potential risk of endobag rupture. Even after puncture of a cystic lesion within the endobag or intra-abdominal reduction in diameter of a solid mass, it might be impossible to remove them without conventional minilaparotomy.
Older instruments (such as the extraction cannula), facilitate delivery of the specimen through the abdominal-wall incision used in general surgery, have only two half cylinders, and are stiff and right-angled, which increases the risk of rupturing a full endobag. Extra-large cannulas that are screwed into the original fascia incision for progressive dilation are another option to remove masses through the abdominal wall, but their use is time-consuming and not widespread in gynecologic surgery.3 Vaginal removal of specimens is also possible.4–6 However, this approach requires a change of patient position during surgery, can be time-consuming, and has the potential risk of complications such as injuries of the bowel or uterus.
The endobag extractor allows safe removal of larger surgical specimens during laparoscopy without conventional minilaparotomy.
Division of Gynecology and Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine, University of Basel, Basel, Switzerland.
Address reprint requests to: Ossi R. Köchli, MD, Department of Obstetrics and Gynecology, School of Medicine, University of Basel, CH-4031 Basel, Switzerland; E-mail: firstname.lastname@example.org
Received April 23, 1999. Received in revised form July 19, 1999. Accepted August 5, 1999.