Survey Highlights Inconsistent Use of Tissue Containment in Gynecologic Surgeries

A recent national survey involving first-year fellows in minimally invasive gynecologic surgery has uncovered significant inconsistencies in the use of FDA-approved containment systems during laparoscopic hysterectomy and myomectomy procedures. Published in Gynecology & Reproductive Health, the study reveals that despite high awareness of containment practices, many surgeons resort to off-label and improvised methods, often driven by cost considerations.

The survey included 31 participants from various U.S. academic centers and demonstrated that manual morcellation remains the predominant technique, with 60% of fellows using manual methods in most cases. Alarmingly, nearly half of the respondents (45%) frequently employed retrieval bags that were never designed or approved for morcellation, raising concerns about safety.

A notable finding was that approximately 35% of surgeons estimated puncture rates in at least 30% of procedures, even when using FDA-cleared containment devices. These punctures, along with off-label use, increase the risk of tissue fragment leakage and potential dissemination of occult malignancies, such as undetected sarcomas.

Experts emphasize that these practices reflect a gap between device design, surgical training, and real-world application. Dr. Phillip Connell from Northwell Health highlighted that nearly half of the fellows reported off-label use, and a significant majority did not consistently adhere to established protocols, signaling a disconnect that could propagate unsafe techniques.

Cost is cited as the primary factor for choosing less suitable, cheaper bags over purpose-built containment systems, despite evidence supporting their safety and effectiveness. The findings underscore the urgent need for better training, improved device design, and institutional support to enforce safer surgical practices.

Overall, the survey indicates a critical need for the gynecologic surgical community to standardize containment approaches and prioritize patient safety to reduce risks associated with tissue dissemination during minimally invasive procedures.