Laparoscopic Tissue Extraction Module
To Tissue Extraction Prep
OBJECTIVES
By the end of this session, the resident will be able to: Name and identify the major components of the Xi Da Vinci systems by completing the Xi checklist.

  1. Understand the history of tissue extraction
  2. Discuss current recommendations for tissue extraction
  3. Describe and demonstrate techniques for tissue extraction
  4. Develop and demonstrate strategies for safe and efficient tissue extraction

TASKS
  1. Perform tissue extraction via contained manual tissue extraction
  2. Review the EXCITE method of tissue extraction
  VIGNETTES
For each of the three Vignettes' described below, consider the following:
  • How would you counsel each patient?
  • What are the available techniques for tissue extraction? 
  • What are the risks of morcellation?
  • What are risk factors for leiomyosarcoma
Vignette 1
38yo P 1001  with abnormal uterine bleeding and secondary infertility - found to have a 10cm posterior Type 2-5 myoma. She wants a myomectomy. 

  1. What routes may be considered for her myomectomy?
  2. How would you counsel her about tissue extraction?
  3. How would you counsel her re: future pregnancy?
Vignette 2
47yo P 2002 with abnormal uterine bleeding secondary to fibroids (AUB-L). You have evaluated her previously and she now returns to your office as she has decided she would like to proceed with a total laparoscopic hysterectomy. She has a BMI of 28 and a 20 week size uterus.
She asks you about how the uterus will be removed with such tiny incisions

  1. What routes may be considered for tissue extraction?
  2. What workup would you require before taking her to the OR?

Vignette 3
52yo P 0000 woman with abnormal uterine bleeding (AUB-L) - found to have an 18 week size uterus enlarged with leiomyomas. Endometrial biopsy revealed Endometrial Intraepithelial Neoplasia. BMI is 44. She desires a laparoscopic hysterectomy. She asks you about how the uterus will be removed with such tiny incisions
  1. What routes may be considered for tissue extraction?
  2. What workup would you require before taking her to the OR?