Safety of in-bag morcellation during laparoscopic myomectomy and hysterectomy: a systematic review and meta-analysis
Abstract
Objective: To systematically evaluate the outcomes of in-bag versus no-bag morcellation during laparoscopic myomectomy and hysterectomy, focusing on safety.Data sources: Searches were conducted in Cochrane Library, Embase, and PubMed, covering studies from inception up to January 31, 2024.Methods of study selection: Inclusion of studies on females undergoing laparoscopic myomectomy and/or hysterectomy with in-bag morcellation, excluding series with fewer than 10 patients.Tabulation, integration and results: Data were synthesized using meta-analysis techniques, with sensitivity analyses for rare events, focusing on intraoperative complications (i.e. a composite outcome including conversion to laparotomy, bowel injury or, accidental injury to any viscus injury or vessel). The secondary outcomes include presence of parasitic fibroma, fragment of myometrium/uterus, blood transfusion, bleeding > 500mL, total operative time, postoperative length of stay, postoperative pain, conversion to laparotomy, postoperative complications and cost. From 1,970 published studies, we included 20 trials, enrolling 5,505 women in the in-bag and 37,283 women in the no-bag group. We included 9 trials in each subgroup: myomectomy and hysterectomy, enrolling 767 and 4678 women in the in-bag; 830 and 36380 women in the no-bag groups, respectively. We observed increased intraoperative complications compared to no-bag morcellation (OR 1.45, 95% CI 1.11;1.89) with a null heterogeneity (I²= 0%). The hysterectomy subgroup analysis showed a significant association between bag and intraoperative complications (OR 1.47, 95% CI 1.12;1.93) but not myomectomy (OR 1.00, 95% CI 0.29;3.43). We did not have enough information to conclude about the presence of parasitic fibroma, fragment of myometrium and costs. No statistical differences were observed concerning the other secondary outcomes.Conclusions: The use of containment bags in morcellation may increase the risk of intra-operative complications, particularly in case of hysterectomy. However, these events might not be directly related to bag use and could represent confounding factors. Further studies are needed to investigate in-bag morcellation.Registration: CRD42023478908 on the International Prospective Register of Systematic reviews. Registered November 19, 2024.
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BibTeX
@article{chene2026safety,
title = {{Safety of in-bag morcellation during laparoscopic myomectomy and hysterectomy: a systematic review and meta-analysis}},
author = {Gautier Chene and Laura Miquel and Aubert Agostini and Sofiane Bendifallah and Céline Solignac and Bernadette Darné and Solène Languille and Krystel Nyangoh Timoh and Marie Carbonnel},
journal = {Journal of Minimally Invasive Gynecology},
year = {2026},
month = oct,
doi = {10.1016/j.jmig.2025.07.002},
url = {https://hal.science/hal-05158169v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Safety of in-bag morcellation during laparoscopic myomectomy and hysterectomy: a systematic review and meta-analysis
AU - Gautier Chene
AU - Laura Miquel
AU - Aubert Agostini
AU - Sofiane Bendifallah
AU - Céline Solignac
AU - Bernadette Darné
AU - Solène Languille
AU - Krystel Nyangoh Timoh
AU - Marie Carbonnel
PY - 2026
DA - 2026/10/30
JO - Journal of Minimally Invasive Gynecology
DO - 10.1016/j.jmig.2025.07.002
UR - https://hal.science/hal-05158169v1
AB - Objective: To systematically evaluate the outcomes of in-bag versus no-bag morcellation during laparoscopic myomectomy and hysterectomy, focusing on safety.Data sources: Searches were conducted in Cochrane Library, Embase, and PubMed, covering studies from inception up to January 31, 2024.Methods of study selection: Inclusion of studies on females undergoing laparoscopic myomectomy and/or hysterectomy with in-bag morcellation, excluding series with fewer than 10 patients.Tabulation, integration and results: Data were synthesized using meta-analysis techniques, with sensitivity analyses for rare events, focusing on intraoperative complications (i.e. a composite outcome including conversion to laparotomy, bowel injury or, accidental injury to any viscus injury or vessel). The secondary outcomes include presence of parasitic fibroma, fragment of myometrium/uterus, blood transfusion, bleeding > 500mL, total operative time, postoperative length of stay, postoperative pain, conversion to laparotomy, postoperative complications and cost. From 1,970 published studies, we included 20 trials, enrolling 5,505 women in the in-bag and 37,283 women in the no-bag group. We included 9 trials in each subgroup: myomectomy and hysterectomy, enrolling 767 and 4678 women in the in-bag; 830 and 36380 women in the no-bag groups, respectively. We observed increased intraoperative complications compared to no-bag morcellation (OR 1.45, 95% CI 1.11;1.89) with a null heterogeneity (I²= 0%). The hysterectomy subgroup analysis showed a significant association between bag and intraoperative complications (OR 1.47, 95% CI 1.12;1.93) but not myomectomy (OR 1.00, 95% CI 0.29;3.43). We did not have enough information to conclude about the presence of parasitic fibroma, fragment of myometrium and costs. No statistical differences were observed concerning the other secondary outcomes.Conclusions: The use of containment bags in morcellation may increase the risk of intra-operative complications, particularly in case of hysterectomy. However, these events might not be directly related to bag use and could represent confounding factors. Further studies are needed to investigate in-bag morcellation.Registration: CRD42023478908 on the International Prospective Register of Systematic reviews. Registered November 19, 2024.
SN - 1553-4650
ER -