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Purpose: One of the most challenging tasks in laparoscopic gynecological surgeries is suturing. Knotless barbed sutures are intended to enable faster suturing and hemostasis. We carried out a meta-analysis to compare the efficacy and safety of V-Loc ™ barbed sutures (VBS) with conventional sutures (CS) in gynecological surgeries., Methods: We systematically searched PubMed and EMBASE for studies published between 2010 and September 2021 comparing VBS to CS for OB/GYN procedures. All comparative studies were included. Primary analysis and subgroup analyses for the different surgery and suturing types were performed. Primary outcomes were operation time and suture time; secondary outcomes included post-operative complications, surgical site infections, estimated blood loss, length of stay, granulation tissue formation, and surgical difficulty. Results were calculated as weighted mean difference (WMD) or risk ratio (RR) and 95% confidence intervals (CI) with a random effects model, and a sensitivity analysis for study quality, study size, and outlier results was performed. PROSPERO registration: CRD42022363187., Results: In total, 25 studies involving 4452 women undergoing hysterectomy, myomectomy, or excision of endometrioma. VBS were associated with a reduction in operation time (WMD - 17.08 min; 95% CI - 21.57, - 12.59), suture time (WMD - 5.39 min; 95% CI - 7.06, - 3.71), surgical site infection (RR 0.26; 95% CI 0.09, 0.78), estimated blood loss (WMD - 44.91 ml; 95% CI - 66.01, - 23.81), granulation tissue formation (RR 0.48; 95% CI 0.25, 0.89), and surgical difficulty (WMD - 1.98 VAS score; 95% CI - 2.83, - 1.13). No difference between VBS and CS was found regarding total postoperative complications or length of stay. Many of the outcomes showed high heterogeneity, likely due to the inclusion of different surgery types and comparators. Most results were shown to be robust in the sensitivity analysis except for the reduction in granulation tissue formation., Conclusion: This meta-analysis indicates that V-Loc ™ barbed sutures are safe and effective in gynecological surgeries as they reduce operation time, suture time, blood loss, infections, and surgical difficulty without increasing post-operative complications or length of stay compared to conventional sutures., (© 2023. The Author(s).)

Introduction: Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy., Materials and Methods: The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation., Results: Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation., Conclusion: The experiences from our small pilot series prove technical feasibility in the clinical setting.

Introduction: Minimal invasive approaches have proven beneficial for patients undergoing myomectomy and hysterectomy, but necessary tissue morcellation carries the risk of cell dissemination in rare cases of inadvertent malignancy. Performing the morcellation process within a contained bag system may prevent spilling and therefore enhance safety of the laparoscopic procedures., Material and Methods: The present study describes the development and experimental evaluation of a new bag system in vitro and in vivo in a pig model of laparoscopic supracervical hysterectomies., Results: The main results on n = 8 procedures with in-bag morcellation compared to n = 8 controls without bag indicate reproducible feasibility and protective effect of the new bag, which is the first published to our knowledge that does not require puncturing in a standard multiport laparoscopy setting. Overall surgery time was significantly prolonged in the bag group by 12.86 min (P = 0.0052; 95 % confidence interval 4.64-21.07), but peritoneal washings were negative for muscle cells in all cases with bag use, compared to positive cytology in 5/8 cases without bag (P = 0.0256)., Conclusion: Clinical trials will now be necessary to investigate the reproducibility of these encouraging data in human application.

Purpose: This study aims to evaluate the number of cases of occult uterine malignancies in all LASH surgeries at the MIC clinic (Berlin) and to verify how the operative technique affects the prognosis of the disease., Methods: Data of 10,731 patients who underwent a standardized LASH surgery with electric power morcellation between 1998 and April 30, 2014 were retrospectively analyzed. Main indication for LASH was symptomatic uterine myomas (81.3 %)., Results: No intra-operative complication was caused by use of a morcellator. In total, six sarcomas (0.06 %), including four endometrial stromal sarcomas (0.04 %) two leiomyosarcomas (0.02 %), and eight endometrial cancers (0.07 %) were documented. This amounts to a very low uterine malignancy rate of 0.13 %. Median follow-up period for all six patients with sarcoma and seven patients with endometrial cancer was 65.58 months (13-169). No recurrence was reported for the patients with endometrial cancer and five sarcoma patients in the comprehensible follow-up period. One patient died 13 months after LASH surgery due to the diagnosed leiomyosarcoma with peritoneal carcinomatosis and bone metastases., Conclusion: In 10,731 morcellated uteri during LASH only 0.06 % sarcoma and 0.07 % endometrial carcinoma were detected. All patients should be informed about the rare possibility of a malignant disease during pre-operative counseling. With a timely follow-up surgery according to the oncologic guidelines, our data suggest a very good prognosis in terms of survival after LASH with morcellation of malignant tumors in the uterus.

Purpose: We use a non-surgical endoloop snare technique to remove prolapsed pedunculated submucous uterine myomas under the concept that ligating the pedicle causes tumor necrosis and natural elimination of the tumor. We evaluated our method on the basis of clinical outcomes., Methods: For pertinent clinical data, we reviewed the hospital records of 11 patients treated by our new method between July 2009 and 2010 and followed up for 22-31 months., Results: Patients' mean age was 40.9 years, and the mean hemoglobin level was 10.6 g/dl. None required urgent hospitalization, blood transfusion, or laparotomy. The tumors were eliminated naturally or removed by cutting necrotic pedicle within 4-11 days. One patient required a second endoloop application. Another one patient required follow-up surgery for a second submucous myoma, adenomyosis, and persistent hypermenorrhea., Conclusions: Endoloop ligation is feasible for eliminating prolapsed pedunculated submucous myoma. It is simple and safe and can be performed in the outpatient setting.

Objective: To present the initial operative outcome and comparative data among patients undergoing single-port laparoscopic myomectomy (SPLM)., Materials and Methods: A prospective, observational study of all patients who underwent SPLM was performed. The demographic and operative data, including age, body mass index, operative indications, operative time, estimated blood loss, complications, and postoperative hospital stay were recorded. A match cohort of patients undergoing traditional LM was also retrospectively compared., Results: SPLM was successfully performed in all ten patients from April 2010 to October 2010. The two groups (SPLM and traditional LM) were matched by age, body mass index, size, and weight of fibroids. The median operating time (196.5 vs. 82.5 min, P < 0.001) and length of hospitalization (3 vs. 2 days, P = 0.042) were significantly longer in SPLM group than in traditional LM group. The median operative blood loss was not significantly different. No patients in either group had serious complications., Conclusion: Despite the increased operating time, SPLM is feasible and offers comparable surgical outcomes and superior cosmesis compared with traditional LM.