Irrigation after Laparoscopic Power Morcellation and the Dispersal of Leiomyoma Cells: A Pilot Study

Study Objective: To evaluate if copious irrigation and suctioning after electromechanical power morcellation will reduce myoma cell dissemination and if there is a difference between sterile water and normal saline. Design: Prospective single-center cohort pilot study (Canadian Task Force classification II-2). Setting: Academic tertiary referral center. Patients: Sixteen women undergoing laparoscopic myomectomy with 1 surgeon between January 1, 2017 and August 31, 2017. Interventions: Peritoneal washings were collected 3 specific times during surgery: after dissection of myoma(s) and hysterotomy repair but before morcellation, after morcellation, and after irrigation with 3 L normal saline or sterile water. The primary outcome was the detection of benign spindle cells (BSCs) in peritoneal washings. Measurements and Main Results: Sixteen patients were enrolled in the study. Eight were randomized to the normal saline group and 8 to the sterile water group. In the normal saline group BSCs were detected in 3 of 8 patients (37.5%) after closure of the hysterotomy but before morcellation, in 3 of 8 (37.5%) after morcellation, and in 0 of 8 (0%) after irrigation and suctioning of the peritoneal cavity with 3 L normal saline. In the sterile water group BSCs were detected in 3 of 8 patients (37.5%) after closure of the hysterotomy but before morcellation, 2 of 8 (25%) after morcellation, and in 0 of 8 (0%) after irrigation and suctioning with 3 L sterile water. Thus, no differences were found between the normal saline and sterile water groups. Conclusion: In this pilot study myoma cells were disseminated before electromechanical morcellation. Irrigation and suctioning with 3 L normal saline or sterile water after morcellation may reduce myoma cell dissemination. (C) 2018 AAGL. All rights reserved.