Forceps Guided Scope Port Insertion Method for MorSafe™ Usage

The MorSafe™ is a type of collection bag to prevent tissue scattering when using a laparoscopic power morcellator for uterus or fibroma removal. The bag has two openings, one large, to contain the specimen and the morcellator, and one small (tail opening), for insertion of the scope. Having experienced some difficulty in inserting the scope through the tail opening, we decided to experiment with the use of forceps. We tried 2 methods, the first involves inserting forceps through the large opening into the tail, passing it through the navel from inside the bag, and using the forceps as a guide for the scope insertion. This proved tricky, with the approximate time from the bag insertion to start of morcellation being 20 minutes. The second method involves inserting forceps through the trocar into the tail opening first pulled out of the abdominal cavity, and used as a guide for trocar insertion. Once the trocar was in place the forceps were removed and replaced by the scope. Having performed the second technique on 8 cases, the average time to morcellation was 10 minutes. Also, by using forceps longer than the trocar, it was easier to keep the tail opening free from slack, thus minimizing resistance and blockage during the scope insertion process. The largest fibroid removed was 466 grams, and the S size bag, with a large opening measuring 125 mm in diameter, and a containment volume of 1600 mls, was sufficient for the procedures.