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Objective: While the use of reduced port surgery is increasing, problems remain with respect to specimen retrieval. In our department, retrieval was previously performed through an 11mm port when operating on adnexal diseases. We are currently exploring the use SLIM BAG II (Hakko Co., Ltd.) for retrieval through a 5 mm port. In this retrospective study, we investigated the feasibility and efficacy of using SLIM BAG II in laparoscopic surgery applied to adnexal diseases. Methods: Between March 2014 and October 2015, 86 patients underwent laparoscopic surgery in our department. These included 36 cases of ectopic pregnancy and 50 cases of other adnexal diseases. Among the ectopic pregnancy surgeries, 12 employed SLIM BAG II using a 5 mm port, and 24 employed probe covers with access through a 11mm port. The SLIM BAG II was used for all 50 surgeries for other adnexal diseases. A total of 62 surgeries were performed using SLIM BAG II, 27 employing small bags, and 35, regular sized bags. We assessed the surgeries with regard to the specimen size, operative time, amount of bleeding, complications, retrieval time, and inflammatory response. Results: There were no complications in any of the 62 surgeries employing SLIM BAG II. The mean specimen size was 34.0±17.2 mm in surgeries using the small bag, and 51.5±27.5 mm in those using regular sized bags. There were no bag size changes during any of the operations. In the cases of ectopic pregnancy, there were no significant differences between the SLIM BAGII and probe cover groups with respect to retrieval times, C-reactive protein levels (postoperative day 1), or pain. White blood cells (postoperative day 1) showed no increase in the SLIM BAG II group, while an increase was observed in the probe cover group (5.97±2.75 vs 8.62±2.79; p=0.005). There was no specimen retrieval leakage in the SLIM BAG II group, but it occurred in three cases in the probe cover group (12.5%). Conclusion: This study showed that SLIM BAG II was feasible and safe for specimen retrieval via a 5 mm port, indicating that the use of these bags could contribute to reduced port surgery. SLIM BAG II is especially recommended for use in extracting thin-walled specimens in adnexal surgeries for ovarian endometrioma, paraovarian cysts, hydrosalpinx, ovarian serous cystadenoma, and ectopic pregnancy.

Feasibility and efficacy of SLIM BAG II use in reduced port surgery