Dr. Greg Marchand’s In-Bag Morcellation Technique for Minimally Invasive Surgery for Cancerous Tumors
I recently had the opportunity to connect with Dr. Greg Marchand MD, an award-winning board-certified obstetrician and gynecologist specializing in minimally invasive surgery.
Recently, The World Record Academy awarded Dr. Greg Marchand and his surgical team the world’s record for removing the largest cancerous tumor — a 17-centimeter (approximately 7 inch) cancerous ovarian tumor removed through In-Bag Morcellation Technique with belly button incision smaller than a dime. Read my Q&A below with Dr. Greg Marchand to learn more about his incredible technique.
YBLTV’s Erik Valainis: What are some of the signs and symptoms of ovarian cancer?
Dr. Greg Marchand MD: Unfortunately, there are very few signs or symptoms of ovarian cancer. Sometimes a new onset of bloating or constipation can alert a woman that something may be wrong, but usually there is very little warning. This makes ovarian cancer a very silent killer, often going undiagnosed until an advanced stage.
YBLTV’s Erik Valainis: What impact did the FDA’s black box warning in 2014 on power morcellation devices have on the medical industry since then?
Dr. Greg Marchand MD: The impact was enormous. Fear of liability led to an almost complete removal of power morcellators from hospital shelves effectively eliminating their use. As a result, the remaining options were to simply cut the patient “wide-open” (technically called a laparotomy) or to develop in-bag morcellation techniques with the hope of containing the potentially cancerous tissues. I would like to think that the “in-bag” morcellation technique that I pioneered will be a useful tool in the fight against ovarian cancer.
YBLTV’s Erik Valainis: While removing cysts and tumors using laparoscopic surgery is standard practice, why is it rare to use the technique in conjunction with an ovarian cancer staging procedure? Why hasn’t the technique ever been accomplished on any malignant tumor this large until now?
Dr. Greg Marchand MD: Laparoscopic or Robotic Assisted Ovarian Cancer staging procedures are a recent advancement in medicine. While more simple procedures, for example, removing the appendix, are almost universally performed through small laparoscopic incisions, a great number of ovarian cancer staging procedures are still performed through a large incision. This is a complex surgery that even with a small tumor can be difficult to accomplish laparoscopically. It is rare to perform the procedure laparoscopically on a large tumor. To our knowledge, and the research of the record accrediting agency, this was the largest malignant tumor to ever receive complete laparoscopic staging. On the day of surgery there was simply the perfect combination of surgeons present to complete the procedure. After I completed the in-bag morcellation and removal of the large tumor, a very skilled gynecologic oncologist was kind enough to present and complete the entire staging laparoscopically.
YBLTV’s Erik Valainis: What criteria do you set when selecting patients as candidates for an in-bag morcellation procedure? Are there any patient conditions that would compromise this type of surgery?
Dr. Greg Marchand MD: For me personally, as I specialize in minimally invasive surgery and not gynecologic oncology, I would refer to an oncologist any tumor that I thought had a good chance of being cancerous. I would defer to their recommendations as to whether an “in-bag” morcellation approach was reasonable. Of the several hundred of theses cases I have performed, only 3 have turned out to be malignant. Factors that could give away the fact that a tumor might be malignant include the makeup of the tumor, meaning if it is solid or cystic, as well as family history of the patient, how mobile the mass is in the pelvis, and the results of special blood tests called “tumor markers.”
YBLTV’s Erik Valainis: Are there limitations as to what surgeries can use some sort of similar in-bag morcellation procedure? Can it be developed to be a possibility for brain tumors? Or for blood clots?
Dr. Greg Marchand MD: I’m going to have to apologize that I’m not an expert in surgery away from the gynecologic organs. I invented the technique to provide a safer way to morcellate tumors in the abdominal cavity, but I am sure some brilliant surgeons somewhere can find ways to use containment bags in other specialties.
YBLTV’s Erik Valainis: Since this procedure reduces recuperative time, will it also reduce the patient’s cost? If so, by what percentage?
Dr. Greg Marchand MD: Yes! There have been many studies on the cost-savings for patients receiving laparoscopic versus open procedures. One popular study showed a savings of about $2300.00 or about 20% when removing a uterus was performed laparoscopically instead of open. The reference for this study is below:
Warren L, Ladapo J, Borah B, Gunnarson C. Open Abdominal Versus Laparoscopic and Vaginal Hysterectomy: Analysis of a Large United States Payer Measuring Quality and Cost of Care. Journal of Minimally Invasive Gynecology. 2009; 16(5):581-88.
YBLTV’s Erik Valainis: As noted the most difficult part of the surgery was removing the cancerous mass without spilling cancer cells into the abdomen. What specific knowledge or skill set determine if a surgeon performing the procedure is deemed proficient?
Dr. Greg Marchand MD: Patient selection is going to be critical. As I said above, it’s critical for a surgeon to avoid getting in over their heads. I always recommend referring a case to a gynecologic oncologist if there is significant evidence of malignancy. Patience is also going to be important. The idea is to perform the technique as minimally invasive as possible, so you want to avoid making larger incisions even though it would speed up the case. Tactile skill is also important, but so is a very intimate knowledge of the instruments you are working with. The last thing you would want to happen would be to overestimate the strength of the bag, or the gentleness of the clamps, and spill the tumor.
YBLTV’s Erik Valainis: The body’s immune system is dysfunctional in cancer. Can certain choices in diet, exercise or lifestyle contribute in causing ovarian cancer? Are some individuals more susceptible than others based on their genetics?
Dr. Greg Marchand MD: From my basic understanding cancer can arise from genetics and environmental factors. I would assume a poor diet or exposure to chemicals such as tobacco would qualify. I have to apologize that medical oncology is not my specialty.
YBLTV’s Erik Valainis: Do you see an end in the fight of cancer? Please share with us any of the newest cancer-fighting drugs on the market or any other advancements in the surgical treatment of cancer that you feel hold great promise.
Dr. Greg Marchand MD: I’ve heard great things about new biologic medicines to treat cancer, but I have to apologize that medical oncology is not my specialty. As for surgical breakthroughs, I just saw in the news that Intuitive (The company that makes the Da Vinci Robot system) and JustRight (that produces miniature laparoscopic instruments) have signed a deal to share their technology. I am excited to see what will come of this. For now, I steer away from the Da Vinci Robot because all of its configurations require incisions I consider too big, or just too many of them. I am excited for a future where robotic surgery can also be more minimally invasive. Also - I am always amazed at the newest miniaturization of laparoscopic instruments. While 5mm to 12mm instruments are still standard for laparoscopy, many new instruments are now available that are as small as 2mm, and can be inserted through an incision not much bigger than a needle hole. I am very excited to see what these technologies will mean for my patients.
Learn More About Dr. Greg Marchand MD
Dr. Greg Marchand MD is originally from Providence, RI, and is a board certified physician in Obstetrics and Gynecology. Dr. Marchand completed training in Obstetrics and Gynecology at the University of Tennessee, and is extensively published in the fields of urogynecology and minimally invasive surgery. Dr. Marchand is recognized internationally as a pioneer in developing laparoscopic techniques, as well as an expert minimally invasive surgeon and teaching surgeon.
Dr. Marchand was recently honored with a World Record for removing a 17cm Malignant tumor using a special laparoscopic cancer staging technique he invented. Dr. Marchand was also one half of the team that was recognized by the Guinness Book of World Records(™) for removing a seven pound uterus without needing to cut open the patient. Dr. Marchand was the first ever surgeon to be recognized by the Surgical Review Corporation and AAGL as a “Surgeon of Excellence in Minimally Invasive Surgery.”
In addition, Dr. Marchand is one of the few OBGYN’s in the country to be SOEMIS Certified, (Surgeon of Excellence in Minimally Invasive Surgery,) as well as being a fellow of both ACOG (American College of Obstetrics and Gynecology) and ACS (American College of Surgeons). When he is not in the operating room, Dr. Marchand enjoys low carb living and chasing around his four year old son, Sebastian.