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Laparoscopic specimen extraction: morcellation
Author(s) -
Varkarakis Ioannis,
Rha Khoon,
Hernandez Fernando,
Kavoussi Louis R.,
Jarrett Thomas W.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05194.x
Subject(s) - medicine , nephrectomy , adipose capsule of kidney , surgery , navel , laparoscopy , renal cell carcinoma , kidney
OBJECTIVES To review our experience with intact extraction and morcellation of nephrectomy specimens, and the advantages and disadvantages of morcellation indicated by current reports. PATIENTS AND METHODS In a previous study, 56 consecutive patients undergoing radical and simple transperitoneal laparoscopic nephrectomy were prospectively evaluated. Morcellation specimens (33) were extracted at the umbilical or lateral port sites and intact specimens (23) through an infra‐umbilical incision. Data were obtained on pathology, narcotic requirements, hospital stay, complications, estimated blood loss, size of renal mass based on preoperative imaging, specimen weight and extraction incision length RESULTS The mean incision length was 1.2 cm in the morcellation group and 7.1 cm in the intact group ( P < 0.001). There were no significant differences in pain or recovery between the groups. In two cases of tumour nephrectomy, microscopic invasion of the perinephric adipose tissue in the intact specimen group were up‐staged from clinical T1 to pT3a disease; there was no change in patient treatment based on this information. CONCLUSIONS With proper technique, morcellation is safe for extracting renal tumours. The specimen can be evaluated for histology but not for pathological staging, limiting its use with transitional cell carcinoma. Port‐site seeding is rare, and does not appear to be more frequent than with open nephrectomy. Although morcellation is cosmetically more desirable, there was no significant advantage in operating time, pain or duration of hospital stay. The choice of extraction method depends on the surgeon's preference and patient choice.