Laparoscopic specimen extraction: Morcellation

Ioannis Varkarakis, Khoon Rha, Fernando Hernandez, Louis R. Kavoussi, Thomas W. Jarrett

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)27-31
Number of pages5
JournalBJU International, Supplement
Volume95
Issue number2
Publication statusPublished - 2005 Mar 1

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Nephrectomy
Umbilicus
Length of Stay
Kidney
Pain
Patient Preference
Transitional Cell Carcinoma
Narcotics
Morcellation
Adipose Tissue
Neoplasms
Histology
Pathology
Weights and Measures
Therapeutics

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Varkarakis, I., Rha, K., Hernandez, F., Kavoussi, L. R., & Jarrett, T. W. (2005). Laparoscopic specimen extraction: Morcellation. BJU International, Supplement, 95(2), 27-31.
Varkarakis, Ioannis ; Rha, Khoon ; Hernandez, Fernando ; Kavoussi, Louis R. ; Jarrett, Thomas W. / Laparoscopic specimen extraction : Morcellation. In: BJU International, Supplement. 2005 ; Vol. 95, No. 2. pp. 27-31.
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Varkarakis, I, Rha, K, Hernandez, F, Kavoussi, LR & Jarrett, TW 2005, 'Laparoscopic specimen extraction: Morcellation', BJU International, Supplement, vol. 95, no. 2, pp. 27-31.

Laparoscopic specimen extraction : Morcellation. / Varkarakis, Ioannis; Rha, Khoon; Hernandez, Fernando; Kavoussi, Louis R.; Jarrett, Thomas W.

In: BJU International, Supplement, Vol. 95, No. 2, 01.03.2005, p. 27-31.

Research output: Contribution to journalArticle

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AU - Varkarakis, Ioannis

AU - Rha, Khoon

AU - Hernandez, Fernando

AU - Kavoussi, Louis R.

AU - Jarrett, Thomas W.

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N2 - 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.

AB - 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.

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Varkarakis I, Rha K, Hernandez F, Kavoussi LR, Jarrett TW. Laparoscopic specimen extraction: Morcellation. BJU International, Supplement. 2005 Mar 1;95(2):27-31.