What Is Contained Morcellation? Techniques and Equipment for Laparoscopic Surgery

What is contained morcellation and why is it used

In open or uncontained morcellation, tissue is cut in the peritoneal cavity and the pieces are removed one by one. This can scatter fragments in the abdomen. Concern about the unexpected spread of undiagnosed malignant tissue has led regulators and professional societies to advise careful patient selection and, where morcellation is used, containment of the specimen.

In contained morcellation the specimen is first placed in a strong bag, the neck of the bag is brought out through a port or incision, and the tissue is cut up inside it under vision. The bag, not the abdomen, holds the fragments. Contained techniques are a standard part of many gynecologic departments' protocols, but local policy and the surgeon's decision always apply.

Contained power morcellation

Contained power morcellation combines an electromechanical morcellator with an insufflated bag. The morcellator's cutting tube passes through a port into the bag, a rotating blade cores and cuts the tissue and the strips are drawn out of the abdomen. The bag is inflated with CO2 so that there is space to work and to see.

The key controls are the speed of the blade, a safe way to deactivate it during insertion and visibility. The ERGO 300 from BOWA, for example, offers cutting speed adjustable between 50 and 1000 rpm via a Vario foot switch, working diameters of 12 and 15 mm, an autoclavable micro motor and blade deactivation for safe insertion. The ERGO 300 morcellator can be combined with MetraBag pro.

Contained hand (manual) morcellation

Contained manual morcellation does not use a motor. After the specimen is bagged, the neck is exteriorised through an enlarged port incision or the vagina, and the surgeon cuts the tissue with a scalpel into strips while the bag is held in place. The method needs no capital equipment but requires a larger access site and care to protect the bag.

Which method is best depends on the size of the specimen, the access route, the surgeon's experience and the equipment available. Some departments keep both techniques in their protocol and choose according to the case.

• Power: motor-driven blade, faster for large specimens
• Manual: scalpel, no capital equipment, larger access
• Both: bag must be intact, with a visual check before and after

Equipment for contained morcellation hysterectomy

For contained morcellation in hysterectomy and myomectomy you need a containment bag, a morcellator for the power method, a laparoscopic tower, trocars of suitable size and instruments to place and manipulate the bag. MetraBag pro is a sterile bag inserted through a 10 mm trocar with a 3.5-litre volume, transparent material and three colour-coded ports that can be closed during and after morcellation.

On the morcellator side, the Nouvag Morcellation Set combines a TCM 3000 BL control unit, foot pedal, Electronic Motor 21, handle set with cutting tube and obturator, and instruments in 12 mm and 15 mm diameters. Compare systems on the points listed in our power morcellator buying guide.

Safety, training and next steps

Containment does not remove all risk. The bag must be checked for integrity, the blade should never be activated outside the bag, and the surgeon must stay in view of the cutting tube. Teams should train together, and the department should keep a protocol that reflects the latest guidance; the debate is covered in our article on power morcellation safety.

Beckfinity can advise on bag and morcellator combinations for your department. Contact us to request a consultation or a quotation.