Is morcellation still used? Containment bags and gynaecological safety

Background: the FDA morcellation warning

Power morcellation breaks a uterine specimen into pieces so that it can be removed through a small laparoscopic incision. In 2014 the US Food and Drug Administration issued a safety communication discouraging the use of laparoscopic power morcellation for removal of the uterus or fibroids in the majority of women, because an unsuspected cancer could be spread. Other regulators and professional societies have since issued guidance of their own.

The practical result has been tighter patient selection, more careful pre-operative assessment and, where morcellation is used, a preference for contained techniques. Your gynaecology department and the relevant UAE authority define the current standard, so confirm local policy. For a general explanation read what is tissue morcellation.

How contained morcellation works

In contained morcellation the specimen is placed inside a sealed bag that is inserted through a port, closed around the instrument and inflated, so that cutting takes place inside the bag. Tissue fragments are removed through the bag opening, and the bag is withdrawn when the work is done.

Containment is intended to reduce the spread of tissue; it does not remove all risk, and the technique requires training. The surgeon decides whether morcellation is appropriate for each patient. Teams often practise bag insertion and port handling in simulation before introducing the technique.

MetraBag pro: features of a containment bag

BOWA's MetraBag pro is a sterile bag for controlled in-bag morcellation during laparoscopic hysterectomy and myomectomy. It supports safe tissue removal and is intended to reduce the risk of abnormal cell dissemination. It is delivered sterile and inserted through a 10 mm trocar.

Its 3.5-litre volume accommodates large specimens, the transparent material keeps surrounding structures visible, and three colour-coded ports can be closed during and after morcellation. CO₂ insufflation of the bag creates generous working space. View the MetraBag pro.

• Sterile bag, 3.5 litres
• Insertion through a 10 mm trocar
• Transparent material
• Three colour-coded, closable ports
• CO₂ insufflation for working space

Morcellator systems used with a containment bag

The bag has to be compatible with the morcellator. The BOWA ERGO 300 is a reusable electromechanical morcellator for laparoscopic hysterectomy and myomectomy with 12 and 15 mm working diameters, speed adjustable from 50 to 1000 rpm and a blade that can be deactivated for safe insertion; it is designed to be combined with the MetraBag pro. See the ERGO 300.

NOUVAG's Morcellation Set is another laparoscopic option for hysterectomy and myoma enucleation with 12 mm and 15 mm instruments. Whichever system you choose, confirm compatibility with your preferred containment bag and ports before purchase. Read the morcellator guide for selection criteria.

What to ask your supplier

Ask for instructions for use, training for surgeons and theatre staff, supply of bags and registration status of each device in the UAE. Request documentation on compatibility between bag, morcellator and trocar sizes. Also ask how bags are packaged and stored, and whether you can trial the system in a simulated set-up.

Beckfinity distributes BOWA and NOUVAG in the UAE. Talk to our specialists to arrange training or a demonstration for your gynaecology team.