A surgeon in Arizona removed a 17-centimeter ovarian tumor through an incision smaller than a dime.
He used a controversial procedure called “in bag morcellation,” where the tumor is bagged while it’s still inside the body. Then, it’s broken up and removed.
Morcellation has been criticized because of its potential for spreading cancer cells, but this doctor believes he has all but eliminated the risk.
A year ago, Kathryn Norris had to have a six-by-five’-centimeter ovarian tumor removed. Dr. Greg Marchand told her he’d be using his version of in bag morcellation.”
He’d go in laparoscopically, break up the tumor and remove it with this device, minimizing the risk of spreading disease.
“It was very comforting to know that this procedure was going to hopefully contain everything so it would not be infiltrating other parts of my body and stuff like that,” she said.
Basically, Dr. Marchand cuts the tumor free, and bags it up.
“Ya know, mine is a technique that relies on bringing the mass up to the instruments, as opposed to going in after it with the instruments and using blunt instruments to make sure you don’t rupture the bag in any way,” he said. “Since this mouth of the bag is exteriorized, on the outside of the patient, there’s really no danger of this tremendous mass getting around and falling back in.”
This allows patients like Kathryn to go home the night of surgery.
“I was feeling really pretty darn good. I did not think that I would be able to leave that quickly,” she said.
Dr. Marchand’s motivation for helping patients recover quickly stems from his own minimally-invasive surgery for testicular cancer.
“When I woke up from that procedure, I really felt strong, he said. “I felt ready to fight the cancer, and I really hope that that's the feeling I give my patients.”
Kathryn Norris’s tumor turned out to be cancerous, but she hasn’t had to have any treatment other than regular blood tests looking for tumor markers.
TOPIC: IN BAG MORCELLATION REMOVES TUMOR SAFELY!
REPORT: MB #4290
BACKGROUND: Most noncancerous tumors and cysts do not cause any symptoms; however some cause a feeling of heaviness or pain in the pelvic area. Doctors may detect a growth during a pelvic examination, but they must use ultrasonography to confirm the diagnosis. Some cysts do disappear on their own, but most may be removed through one or more small incisions or just one large incision into the abdomen. On occasion, the affected ovary may also need to be removed. Cysts are fluid-filled sacks that form on or in an ovary, most are benign, and cancerous cysts are more likely to occur in women over the age of 40.
TREATMENT: Some cysts may require surgery. If the cysts are less than two inches in diameter they usually disappear without any treatment. But if a cyst or tumor needs to be removed, laparoscopy or laparotomy is done when possible. Laparoscopy requires one or more small incisions in the abdomen, it is done in a hospital setting and usually requires general anesthetic, but many women do not have to stay overnight. Laparotomy is similar, but requires a larger incision and the patient must stay overnight in the hospital. Which procedure is chosen depends on whether any organs are affected and how large the growth is.
IN BAG MORCELLATION: Morcellation has been criticized for its potential to spread cancer cells, which led to an FDA black box warning in 2014 on power morcellation devices. As a result, they are not usually used anymore. The alternative however, of cutting a patient open with a much larger incision also has its drawbacks and risks. In bag morcellation, using an incision smaller than a dime, allows a surgeon to cut the tumor free, then bag it. They then exteriorize the mouth of the bag, and break the tumor into pieces, removing each piece. This technique is minimally invasive, allowing the patient to usually go home the same day as surgery.
(Source: Greg Marchand, MD)
MORE FROM DR. MARCHAND: “I have performed the technique roughly three to four hundred times. All but three of the masses turned out to be benign. The patient that appears in the interview, the world record surgery and one other patient are the only three times when the pathology showed to be cancerous. Obviously I very carefully select patients as candidates for in-bag morcellation because I am attempting to avoid morsellating a cancer, even though I believe my technique is extremely safe for removing cancerous lesions.”
(Source: Greg Marchand, MD)