“Contain before transection, contain before manual morcellation” with a tissue pouch in laparoendoscopic single-site subtotal hysterectomy

This work proposes a modified method for removing the uterine body in laparoendoscopic single-site subtotal hysterectomy based on the principle of “contain before transection, and contain before manual morcellation,” using a surgical tissue pouch (LapSac, Cook Inc., Bloomington, IN, USA). The main advantage of this method is a low likelihood of a bag rupture during manual morcellation which minimizes the potential risk of iatrogenic parasitic myoma and/or cancer cell dissemination. This method also benefits from lower cost, less surgical time, and “containing before transection” makes the shifting of uterine specimens in the laparoendoscopic single-site more feasible. The limitations of this method, and potential means of overcoming them, are also discussed. Potentially, this method of “contain before transection, contain before manual morcellation” can be applied to other organ tissue removal in laparoscopic surgeries but more cases must be studied to confirm its safety and feasibility