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Миома матки, лапароскопическая хирургия и морцелляция.
Миома матки, лапароскопическая хирургия и морцелляция.
Серегин А.А., Надежденская А.Б., Асатурова А.В., Оводенко Д.Л. Миома матки, лапароскопическая хирургия и морцелляция. Обзор литературы. Гинекология. 2019; 21 (3): 22–25.
DOI: 10.26442/20795696.2019.3.190518
DOI: 10.26442/20795696.2019.3.190518
DOI: 10.26442/20795696.2019.3.190518
________________________________________________
DOI: 10.26442/20795696.2019.3.190518
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Провести анализ литературных данных, касающихся современных подходов к морцелляции миоматозных узлов в лапароскопической хирургии, и осветить данную область в историческом аспекте. Сформировать представление об основных трудностях, связанных с морцелляцией, которые способствовали и способствуют совершенствованию техники данной манипуляции.
Материалы и методы. В обзор включены данные зарубежных статей, опубликованных в базах eLibrary.ru и PubMed по данной теме.
Результаты. Описаны как современные направления в хирургическом лечении больных миомой матки, так и исторические аспекты совершенствования методик, направленных на снижение рисков, сокращение времени оперативного вмешательства и повышение его безопасности. Проанализированы данные о применении электроморцелляции, проводимой как с применением пластиковых контейнеров, так и без них.
Заключение. Высокие требования к хирургическим вмешательствам способствовали появлению такого метода интракорпорального фрагментирования препаратов, как морцелляция, который привел к существенному снижению доли лапаротомических операций при лечении пациенток с миомами матки. Внедрение лапароскопии в хирургическое лечение при миоме матки позволило достигнуть принципиально нового высокого уровня реабилитации пациенток. Извлечение удаленных препаратов из брюшной полости при этом связано с определенным риском. Несмотря на значительное количество предложенных методов и устройств для морцелляции, все они требуют дальнейшего совершенствования, так как необходимо полное исключение контакта ткани миоматозного узла с органами брюшной полости в процессе извлечения. В настоящее время продолжается активное исследование способов, позволяющих реализовать все преимущества малоинвазивных технологий с соблюдением правил онкологической безопасности.
Ключевые слова: миома матки, морцелляция, миомэктомия, пластиковые контейнеры.
To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation.
Materials and methods. The review includes data from foreign articles published in the eLibrary.ru and PubMed databases on this topic.
Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them.
Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.
Key words: uterine myoma, morcellation, myomectomy, plastic containers.
Материалы и методы. В обзор включены данные зарубежных статей, опубликованных в базах eLibrary.ru и PubMed по данной теме.
Результаты. Описаны как современные направления в хирургическом лечении больных миомой матки, так и исторические аспекты совершенствования методик, направленных на снижение рисков, сокращение времени оперативного вмешательства и повышение его безопасности. Проанализированы данные о применении электроморцелляции, проводимой как с применением пластиковых контейнеров, так и без них.
Заключение. Высокие требования к хирургическим вмешательствам способствовали появлению такого метода интракорпорального фрагментирования препаратов, как морцелляция, который привел к существенному снижению доли лапаротомических операций при лечении пациенток с миомами матки. Внедрение лапароскопии в хирургическое лечение при миоме матки позволило достигнуть принципиально нового высокого уровня реабилитации пациенток. Извлечение удаленных препаратов из брюшной полости при этом связано с определенным риском. Несмотря на значительное количество предложенных методов и устройств для морцелляции, все они требуют дальнейшего совершенствования, так как необходимо полное исключение контакта ткани миоматозного узла с органами брюшной полости в процессе извлечения. В настоящее время продолжается активное исследование способов, позволяющих реализовать все преимущества малоинвазивных технологий с соблюдением правил онкологической безопасности.
Ключевые слова: миома матки, морцелляция, миомэктомия, пластиковые контейнеры.
________________________________________________
To form an idea of the main difficulties associated with morcellation, which contributed to and contribute to the improvement of the technique of this manipulation.
Materials and methods. The review includes data from foreign articles published in the eLibrary.ru and PubMed databases on this topic.
Results. It describes both modern trends in the surgical treatment of patients with uterine myoma, and historical aspects of improving methods aimed at reducing risks, reducing the time of surgical intervention and improving its safety. Analyzed data on the use of electromorcellation, carried out both with the use of plastic containers, and without them.
Conclusion. High requirements for surgical interventions contributed to the emergence of such a method of intracorporeal fragmentation of drugs, such as morcellation, which led to a significant reduction in the proportion of laparotomic operations in the treatment of patients with my uterus. The introduction of laparoscopy in the surgical treatment of uterine myoma allowed to achieve a fundamentally new high level of rehabilitation of patients. Removing removed drugs from the abdominal cavity is associated with a certain risk. Despite the significant number of proposed methods and devices for morcellation, they all require further improvement, since it is necessary to completely exclude contact of the myoma node tissue with abdominal organs in the extraction process. Currently, active research continues on ways to realize all the benefits of minimally invasive technologies in compliance with the rules of oncological safety.
Key words: uterine myoma, morcellation, myomectomy, plastic containers.
Полный текст
Список литературы
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12. Balgobin S, Maldonado PA, Chin K et al. Safety of manual morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2016; 23: 542–7. DOI: 10.1016/j.jmig.2016.01.014
13. Winner B, Porter A, Velloze S et al. Uncontained compared with contained power morcellation in total laparoscopic hysterectomy. Obstet Gynecol 2015; 126: 834–8. DOI: 10.1097/AOG.0000000000001039
14. Srouji SS, Kaser DJ, Gargiulo AR. Techniques for contained morcellation in gynecologic surgery. Fertil Steril 2015; 103: e34. DOI: 10.1016/j.fertnstert.2015.01.022
15. Adelman MR. The morcellation debate: the history and the science. Clin Obstet Gynecol 2015; 58 (4): 710–7. DOI: 10.1097/GRF.0000000000000150
16. Taylan E, Sahin C, Zeybek B et al. Contained morcellation: review of current methods and future directions. Front Surg 2017; 4: 15. DOI: 10.3389/fsurg.2017.00015
17. Driessen SR, Arkenbout EA, Thurkow AL et al. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21 (3): 377–83. DOI: 10.1016/j.jmig.2013.12.121
18. Kho KA, Nezhat CH. Evaluating the risks of electric uterine morcellation. J Am Med Assoc 2014; 311: 905–6. DOI: 10.1001/jama.2014.1093
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20. Cucinella G, Granese R, Calagna G et al. Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril 2011; 96: e90–e96. DOI: 10.1016/j.fertnstert.2011.05.095
21. Leren V, Langebrekke A, Qvigstad E. Parasitic leiomyomas after laparoscopic surgery with morcellation. Acta Obstet Gynecol Scand 2012; 91: 1233–6. DOI: 10.1111/j.1600-0412.2012.01453.x
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J Gynecol Cancer 2017; 27. DOI: 10.1097/IGC.0000000000000911
23. Brolmann H et al. Options on fibroid morcellation: a literature review. Gynecol Surg 2015; 12: 3–15. DOI: 10.1007/s10397-015-0878-4
24. Ton R, Kilic GS, Phelps JY. A medical-legal review of power morcellation in the face of the recent FDA warning and litigation. J Minim Invasive Gynecol 2015; 22 (4): 564–72. DOI: 10.1016/j.jmig.2015.01.017
25. Medical devices; obstetrical and gynecological devices; classification of the gynecologic laparoscopic power morcellation containment system. Final order. Fed Regist 2016; 81 (119): 40181–3.
26. Van Den Haak L, Arkenbout EA, Sandberg EM, Jansen FW. Power morcellator & features affecting tissue spill in gynecologic laparoscopy: in-vitro study. J Minim Invasive Gynecol 2016; 23: 107–12. DOI: 10.1016/j.jmig.2015.09.014
27. Cohen SL, Morris SN, Brown DN et al. Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016; 214: 257.e1–257e1-6. DOI: 10.1016/j.ajog.2015.08.076
28. Cohen SL, Greenberg JA, Wang KC et al. Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study. J Minim Invasive Gynecol 2014; 21: 935–9. DOI: 10.1016/j.jmig.2014.06.004
29. Akdemir A, Taylan E, Zeybek B et al. Innovative technique for enclosed morcellation using a surgical glove. Obstet Gynecol 2015; 125: 1145–9. DOI: 10.1097/AOG.0000000000000823
2. Ottarsdottir H, Cohen SL, Cox M et al. Trends in Mode of hysterectomy after the U.S. food and drug administration power morcellation advisory. Obstet Gynecol 2017; 129: 1014–21. DOI: 10.1097/AOG.0000000000002058
3. Allen E. Vaginal removal of the uterus by morcellation. Am J Obstet Gynecol 1949; 57: 692–700.
4. Semm K. Morcellement and suturing using pelviscopy: not a problem anymore [in German]. Geburtshilfe Frauenheilkd 1991; 51: 843–6.
5. Steiner RA, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 1993; 81: 471–4. PMID: 8437807
6. American Association of Gynecologic Laparoscopists. AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol 2014; 21: 517–30.
7. Einarsson JI, Cohen SL, Fuchs N, Wang KC. In bag morcellation. J Minim Invasive Gynecol 2014; 21: 951–3. DOI: 10.1016/j.jmig.2014.04.010
8. Isakov A, Murdaugh KM, Burke WC et al. A new laparoscopic morcellator using an actuated wire mesh and bag. J Med Devices 2014; 8: 011009. https://biodesign.seas.harvard.edu/publications/faster-and-safer-laparoscopic-morcellation-using-act...
9. Driessen SR, Arkenbout EA, Thurkow AL, Jansen FW. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21: 377–83. DOI: 10.1016/j.jmig.2013.12.121
10. McKenna JB, Kanade T, Choi S et al. The Sydney contained in bag morcellation technique. J Minim Invasive Gynecol 2014; 21: 984–5. DOI: 10.1016/j.jmig.2014.07.007
11. Montella F, Riboni F, Cosma S et al. A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy. Surg Endosc 2014; 28: 1949–53. DOI: 10.1007/s00464-014-3422-0
12. Balgobin S, Maldonado PA, Chin K et al. Safety of manual morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2016; 23: 542–7. DOI: 10.1016/j.jmig.2016.01.014
13. Winner B, Porter A, Velloze S et al. Uncontained compared with contained power morcellation in total laparoscopic hysterectomy. Obstet Gynecol 2015; 126: 834–8. DOI: 10.1097/AOG.0000000000001039
14. Srouji SS, Kaser DJ, Gargiulo AR. Techniques for contained morcellation in gynecologic surgery. Fertil Steril 2015; 103: e34. DOI: 10.1016/j.fertnstert.2015.01.022
15. Adelman MR. The morcellation debate: the history and the science. Clin Obstet Gynecol 2015; 58 (4): 710–7. DOI: 10.1097/GRF.0000000000000150
16. Taylan E, Sahin C, Zeybek B et al. Contained morcellation: review of current methods and future directions. Front Surg 2017; 4: 15. DOI: 10.3389/fsurg.2017.00015
17. Driessen SR, Arkenbout EA, Thurkow AL et al. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21 (3): 377–83. DOI: 10.1016/j.jmig.2013.12.121
18. Kho KA, Nezhat CH. Evaluating the risks of electric uterine morcellation. J Am Med Assoc 2014; 311: 905–6. DOI: 10.1001/jama.2014.1093
19. Nieboer TE, Johnson N, Lethaby A et al. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev 2009; (3): CD003677. DOI: 10.1002/14651858.CD003677.pub4
20. Cucinella G, Granese R, Calagna G et al. Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril 2011; 96: e90–e96. DOI: 10.1016/j.fertnstert.2011.05.095
21. Leren V, Langebrekke A, Qvigstad E. Parasitic leiomyomas after laparoscopic surgery with morcellation. Acta Obstet Gynecol Scand 2012; 91: 1233–6. DOI: 10.1111/j.1600-0412.2012.01453.x
22. Halaska M, Haidopoulos D, Guyon F et al. European society of gynecological oncology statement on fibroid and uterine morcellation. Int
J Gynecol Cancer 2017; 27. DOI: 10.1097/IGC.0000000000000911
23. Brolmann H et al. Options on fibroid morcellation: a literature review. Gynecol Surg 2015; 12: 3–15. DOI: 10.1007/s10397-015-0878-4
24. Ton R, Kilic GS, Phelps JY. A medical-legal review of power morcellation in the face of the recent FDA warning and litigation. J Minim Invasive Gynecol 2015; 22 (4): 564–72. DOI: 10.1016/j.jmig.2015.01.017
25. Medical devices; obstetrical and gynecological devices; classification of the gynecologic laparoscopic power morcellation containment system. Final order. Fed Regist 2016; 81 (119): 40181–3.
26. Van Den Haak L, Arkenbout EA, Sandberg EM, Jansen FW. Power morcellator & features affecting tissue spill in gynecologic laparoscopy: in-vitro study. J Minim Invasive Gynecol 2016; 23: 107–12. DOI: 10.1016/j.jmig.2015.09.014
27. Cohen SL, Morris SN, Brown DN et al. Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016; 214: 257.e1–257e1-6. DOI: 10.1016/j.ajog.2015.08.076
28. Cohen SL, Greenberg JA, Wang KC et al. Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study. J Minim Invasive Gynecol 2014; 21: 935–9. DOI: 10.1016/j.jmig.2014.06.004
29. Akdemir A, Taylan E, Zeybek B et al. Innovative technique for enclosed morcellation using a surgical glove. Obstet Gynecol 2015; 125: 1145–9. DOI: 10.1097/AOG.0000000000000823
2. Ottarsdottir H, Cohen SL, Cox M et al. Trends in Mode of hysterectomy after the U.S. food and drug administration power morcellation advisory. Obstet Gynecol 2017; 129: 1014–21. DOI: 10.1097/AOG.0000000000002058
3. Allen E. Vaginal removal of the uterus by morcellation. Am J Obstet Gynecol 1949; 57: 692–700.
4. Semm K. Morcellement and suturing using pelviscopy: not a problem anymore [in German]. Geburtshilfe Frauenheilkd 1991; 51: 843–6.
5. Steiner RA, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 1993; 81: 471–4. PMID: 8437807
6. American Association of Gynecologic Laparoscopists. AAGL practice report: morcellation during uterine tissue extraction. J Minim Invasive Gynecol 2014; 21: 517–30.
7. Einarsson JI, Cohen SL, Fuchs N, Wang KC. In bag morcellation. J Minim Invasive Gynecol 2014; 21: 951–3. DOI: 10.1016/j.jmig.2014.04.010
8. Isakov A, Murdaugh KM, Burke WC et al. A new laparoscopic morcellator using an actuated wire mesh and bag. J Med Devices 2014; 8: 011009. https://biodesign.seas.harvard.edu/publications/faster-and-safer-laparoscopic-morcellation-using-act...
9. Driessen SR, Arkenbout EA, Thurkow AL, Jansen FW. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21: 377–83. DOI: 10.1016/j.jmig.2013.12.121
10. McKenna JB, Kanade T, Choi S et al. The Sydney contained in bag morcellation technique. J Minim Invasive Gynecol 2014; 21: 984–5. DOI: 10.1016/j.jmig.2014.07.007
11. Montella F, Riboni F, Cosma S et al. A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy. Surg Endosc 2014; 28: 1949–53. DOI: 10.1007/s00464-014-3422-0
12. Balgobin S, Maldonado PA, Chin K et al. Safety of manual morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2016; 23: 542–7. DOI: 10.1016/j.jmig.2016.01.014
13. Winner B, Porter A, Velloze S et al. Uncontained compared with contained power morcellation in total laparoscopic hysterectomy. Obstet Gynecol 2015; 126: 834–8. DOI: 10.1097/AOG.0000000000001039
14. Srouji SS, Kaser DJ, Gargiulo AR. Techniques for contained morcellation in gynecologic surgery. Fertil Steril 2015; 103: e34. DOI: 10.1016/j.fertnstert.2015.01.022
15. Adelman MR. The morcellation debate: the history and the science. Clin Obstet Gynecol 2015; 58 (4): 710–7. DOI: 10.1097/GRF.0000000000000150
16. Taylan E, Sahin C, Zeybek B et al. Contained morcellation: review of current methods and future directions. Front Surg 2017; 4: 15. DOI: 10.3389/fsurg.2017.00015
17. Driessen SR, Arkenbout EA, Thurkow AL et al. Electromechanical morcellators in minimally invasive gynecologic surgery: an update. J Minim Invasive Gynecol 2014; 21 (3): 377–83. DOI: 10.1016/j.jmig.2013.12.121
18. Kho KA, Nezhat CH. Evaluating the risks of electric uterine morcellation. J Am Med Assoc 2014; 311: 905–6. DOI: 10.1001/jama.2014.1093
19. Nieboer TE, Johnson N, Lethaby A et al. Surgical approach to hysterectomy for benign gynecological disease. Cochrane Database Syst Rev 2009; (3): CD003677. DOI: 10.1002/14651858.CD003677.pub4
20. Cucinella G, Granese R, Calagna G et al. Parasitic myomas after laparoscopic surgery: an emerging complication in the use of morcellator? Description of four cases. Fertil Steril 2011; 96: e90–e96. DOI: 10.1016/j.fertnstert.2011.05.095
21. Leren V, Langebrekke A, Qvigstad E. Parasitic leiomyomas after laparoscopic surgery with morcellation. Acta Obstet Gynecol Scand 2012; 91: 1233–6. DOI: 10.1111/j.1600-0412.2012.01453.x
22. Halaska M, Haidopoulos D, Guyon F et al. European society of gynecological oncology statement on fibroid and uterine morcellation. Int
J Gynecol Cancer 2017; 27. DOI: 10.1097/IGC.0000000000000911
23. Brolmann H et al. Options on fibroid morcellation: a literature review. Gynecol Surg 2015; 12: 3–15. DOI: 10.1007/s10397-015-0878-4
24. Ton R, Kilic GS, Phelps JY. A medical-legal review of power morcellation in the face of the recent FDA warning and litigation. J Minim Invasive Gynecol 2015; 22 (4): 564–72. DOI: 10.1016/j.jmig.2015.01.017
25. Medical devices; obstetrical and gynecological devices; classification of the gynecologic laparoscopic power morcellation containment system. Final order. Fed Regist 2016; 81 (119): 40181–3.
26. Van Den Haak L, Arkenbout EA, Sandberg EM, Jansen FW. Power morcellator & features affecting tissue spill in gynecologic laparoscopy: in-vitro study. J Minim Invasive Gynecol 2016; 23: 107–12. DOI: 10.1016/j.jmig.2015.09.014
27. Cohen SL, Morris SN, Brown DN et al. Contained tissue extraction using power morcellation: prospective evaluation of leakage parameters. Am J Obstet Gynecol 2016; 214: 257.e1–257e1-6. DOI: 10.1016/j.ajog.2015.08.076
28. Cohen SL, Greenberg JA, Wang KC et al. Risk of leakage and tissue dissemination with various contained tissue extraction (CTE) techniques: an in vitro pilot study. J Minim Invasive Gynecol 2014; 21: 935–9. DOI: 10.1016/j.jmig.2014.06.004
29. Akdemir A, Taylan E, Zeybek B et al. Innovative technique for enclosed morcellation using a surgical glove. Obstet Gynecol 2015; 125: 1145–9. DOI: 10.1097/AOG.0000000000000823
________________________________________________
2. Ottarsdottir H, Cohen SL, Cox M et al. Trends in Mode of hysterectomy after the U.S. food and drug administration power morcellation advisory. Obstet Gynecol 2017; 129: 1014–21. DOI: 10.1097/AOG.0000000000002058
3. Allen E. Vaginal removal of the uterus by morcellation. Am J Obstet Gynecol 1949; 57: 692–700.
4. Semm K. Morcellement and suturing using pelviscopy: not a problem anymore [in German]. Geburtshilfe Frauenheilkd 1991; 51: 843–6.
5. Steiner RA, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol 1993; 81: 471–4. PMID: 8437807
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Авторы
А.А. Серегин*1, А.Б. Надежденская2, А.В. Асатурова1, Д.Л. Оводенко1
1. ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
2. ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*ggk32@ya.ru
1. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*ggk32@ya.ru
1. ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия;
2. ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*ggk32@ya.ru
________________________________________________
1. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia;
2. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*ggk32@ya.ru
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