A Safe Technique of Laparoscopic Tissue Extraction for a 1kg Uterus Using an Insufflated Bag

STUDY OBJECTIVE: Tackle the challenges of large specimen extraction in minimally invasive gynecologic surgery. DESIGN: We describe the use of an insufflated bag during a total laparoscopic hysterectomy (TLH) for a 1kg uterus. SETTING: TLH for a large uterus, patient in Trendelenburg position, 4 trocars inserted, incision at the Palmer point. PATIENTS OR PARTICIPANTS: 39 year old G1P1 patient (1 cesarean-section), with a body mass index of 28, and a 15 cm uterus causing abdominal pain. INTERVENTIONS: TLH and bilateral salpingectomy, power morcellation contained in a 50cmx50cm plastic bag, insufflated in the abdomen, under direct vision. MEASUREMENTS AND MAIN RESULTS: Estimated blood loss of 100ml, no visible fibroid tissue left in the abdomen, post-operative day 1 hemoglobin of 126 g/L, patient discharged on post-operative day 1. Operative time of 90 minutes. CONCLUSION: We describe a safe and effective technique to extract a large specimen by laparoscopy using a plastic bag insufflated in the abdomen.