Uterine morcellation of presumed leiomyomas inadvertently results in an increase in morcellated uterine leiomyosarcoma. The current practice of morcellation is being scrutinized as it poses a risk of spreading unsuspected uterine sarcoma within the abdomen and pelvis which significantly worsening patient’s long term survival. Therefore, minimally invasive surgeons have been in search of a safe morcellation technique. Morcellation of large specimens within a plastic bag offers minimally invasive surgeons a viable alternative for removal, prevent spillage and therefore enhance safety of laparoscopic procedures. Furthermore, in low resource centre like Sungai Petani, Kedah with budget constrain, we still able to morcellate leiomyoma in a contained environment within the abdominal cavity.

The steps of laparoscopic myomectomy remain the same as done in a standardized way leaving the fibroid separated in the peritoneal cavity. The left lower port is widened to pass a 10-mm port and introduce grasper carrying the modified plastic bag into the peritoneal cavity. The bag is self-innovative by using food container plastic bag. The plastic bag is folded like a fan and introduced it through the 10 mm port. Once the bag is seen inside the sleeve in the abdomen through the laparoscope, the plastic is hold with atraumatic grasper allowing the removal of the plastic bag from the port and is directed straight to the pouch of Douglas (POD). The remaining part of the mouth of the bag is pulled systematically with atraumatic graspers. Once full bag is inside the abdomen, the mouth of the plastic bag is open widely. The leiomyoma is inserted into the plastic bag and is bring near the abdominal cavity. Morcellation is performed under direct vision in a contained environment. Once complete, all fragments are removed and the bag is removed.

We proposed this technique for management of morcellation process of large uterine myomas after laparoscopic myomectomy in order to minimize the risk of dissemination occult leiomyosarcomas myoma fragments throughout the abdominal cavity.