Dear Dr volodymyr

if i feel the danger of perforation i use metz instead of cauter

read my paper on reusable retrieval bag. published 2014 for this copmplication during laparoscpic surgery. A.E.Lasheen, et al. Surg Chron 2014; 19(3):129-132.

Easy, safe, reusable, cost effective specimen retrieval bag for laparoscopic surgery.

Ahmed

E.

Lasheen

, Khaled Safwat

, Ayman Salem, Zaki Allam, Wael Awad.

General and Laparoscopic Surgery Department, Faculty of Medicine, Zagazig University 44519, Egypt.

Abstract:

To offer easy, mini nvasive and reusable specimen retrieval bag that can be used to reduce the cost of aparoscopic surgery. One hundred patients (55 laparoscopic appendectomy and 45 laparoscopic cholecystectomy) from April 2012 to October 2013, during which the reusable retrieval bag was used to remove the specimen. This bag was formed of stainless steel

p

a

rt

and

covered by transparent strong plastic bag. Follow up period ranged from 3 to 18 months. This reusable retrieval bag was used

to

extract the specimens from 55 patients who underwent laparoscopic appendectomy and 45 patients who underwent

laparoscopic ch

olecystectomy. This technique was easy, safe and no bags rupture. No complications were observed in this

patients group such as wound infection or herniation, ileus, and intestinal adhesion. The total cost of operation was reduced

.

The retrieval of specime

ns during laparoscopic surgery by using reusable retrieval bag is safe, easy, minimal invasive and cost

-

effective.

Keys words: reusable retrieval bag, laparoscopic surger

Dear colleagues,

Thank you for the posts.

The use of laparoscopic scissors reduces the risk of perforation. But, in spite of best efforts of surgeons at prevention, gallbladder perforation and stone spillage will sometimes occur. The incidents of gallbladder perforation during laparoscopic surgery varying from 10% to 40%, a 7.3% incidence of gallstone spillage, and an estimated 33% of unretrieved gallstones (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662733/). Application of retrieval bag to remove the specimen reduces risks, but does not protect against loss of gallstones through perforated aperture on step of dissection of the gallbladder from its bed.

When perforation, which occurred at the stage of dissection, we use such methods:

1.Method to be based on use bag. Infundibular part of gallbladder localized in a bag and completely intersect by scissors. Cutted part of the gallbladder and concrements need placed in the bag. After this we continue to dissection the empty part of the gallbladder.

2. To prevent stone spillage is useful apply a sterile spherical foam rubber obturator. The diameter of the obturator exceeds that of the transverse section of gallbladder. Obturator in compressed state is inserted into the cavity of the gallbladder via the tubular guide with the aid of piston-like pusher. Obturator expanding and shuts the perforated orifice.

It would be interesting to learn about other options.

Kind regards, V. Fedoruk

I think nothing can be used better than the retrieval bag if available...if not we can use sterile glove instead

1) place gauze square / Raytec in hepatorenal pouch and place all stones onto this; at end of operation place Raytec + stones into endocatch

2) place stones into sterile glove but be careful when extracting from umbilicus so as not to spill stones intraperitoneally

no, most retrieval bags can not be opened once they are closed ie more stones can not be placed into the bag once it is closed. That is the main factor in favour of the glove technique

I think the best and cheapest and practice way is using the steril surgical gloves...

Custom made sterile gloves that are powder free and thoroughly washed with saline and its fingers are transfixed with a suture and cut shortly to leave a very short stump for easy insertion through a 10/12 mm port....followed by insertion of the distal end of the GB in it after clipping and division of both cystic duct and artery, and proceeding with "intta-glove" dissection of the GB from liver bed.

Bert nylon bag + jumbo gallstone suction device

i agree with Dr osman the use of surgical glove after perforation of gall bladder is simple, effective and cheap.

Laparoscopic Retrieval bag works well, in combination with suction and careful irrigation, until fluid is clear and no debris seen in GB bed and perihepatic areas.