Methods of tissue extraction in advanced laparoscopy

Advances in laparoscopic surgery have revolved not only around new methods of tissue excision and repair, but also around specimen extraction. At the center of these recent advances is the need to be cost-effective and safe. Two particularly important advances in laparoscopic tissue extraction are u se of electronic power morcellators, to cut up and remove large masses, and specimen bags to remove the extracted tissue safely. Although morcellators offer tremendous time savings, and can actually reduce the risk of hernia formation because fascia need not be torn or stretched, the use of power mo rcellators is not without concern. The sharp rotating blade can damage norm al organs. Furthermore, one must watch closely so that morcellated specimen s are not inadvertently misplaced. Specimen bags are also important, both i n malignant and in benign conditions. Ultimately, the problem is spillage o f tissue, whether it be cancer cells or products of conception. Although so me specimen bags are equipped with self-opening devices, the largest bags m ust be opened manually. (C) 2001 Lippincott Williams & Wilkins.