Tissue removal utilizing Steiner Morcellator (TM) within a Lapsac (TM): Effects of a fluid-filled environment

Background and Purpose: Tissue removal can be a simple process of withdrawa l of the entire organ, piecemeal removal with surgical clamps, or mechanica l morcellation, Different mechanical morcellators exist that each have adva ntages and disadvantages. We have investigated a particular morcellator hav ing an internal mechanized blade system that increases the chances of damag e to tissue isolation sacks but removes large volumes of intact organ that can more readily be evaluated histologically, The primary premise of this i nvestigation is that a fluid-filled sack would be less likely to be damaged by the activated blades of the morcellator, Materials and Methods: Utilizing a Steiner Morcellator (TM) (Karl Storz, Cu lver City, CA), two porcine kidneys were morcellated within the large LapSa c (TM) (Cook Urological, Spencer, IN). Two environmental variables were eva luated: dry sac morcellation and fluid-filled sac morcellation. Each sessio n was timed, fluid leakage identified, grasping of the sacks quantified, an d gross spillage noted, The tissues were submitted for pathologic evaluatio n to quantify any differences grossly or histologically. All LapSacs were i nspected for gross violation and inflated to distention with fluid to check for tiny leaks. Results: The Steiner Morcellator worked much better within the confines of the LapSac filled with fluid. There were no perforations in our experimenta l setting. It was not possible discern use of fluid-filled sacks histologic ally, Conclusions: The Steiner Morcellator can be utilized safely in the LapSac i f cautious observation and fluid-filled sack conditions are maintained. The extracted tissue is easily evaluated histologically.