Incisional hernia after specimen extraction in minimally invasive gynaecologic surgery: a systematic review

The location and size of abdominal incisions to enable tissue extraction might increase the risk of incisional hernia (IH).

To determine the reported incidence of IH after specimen extraction in gynaecological minimally invasive surgery.

On January 9^th 2025 we performed a systematic literature review of PubMed, Embase, and Clarivate Analytics/Web of Science Core Collection from inception to 25 May 2023. Minimally invasive surgery, IH, specimen extraction, morcellation and gynaecology were used as search terms. All cohort studies and randomised controlled trials reporting IHs after minimally invasive gynaecological surgery with either morcellation or abdominal specimen extraction through an enlarged trocar site or mini-laparotomy were included.

The primary outcome was the incidence of IH. Secondary outcomes included incision length and location, time to diagnosis and risk factors for developing IH.

Thirty one studies were identified, of which three retrospective cohort studies met the inclusion criteria. The reported incidence of IH was between 0.02% and 8.3%, with a time to diagnosis spanning two days to two and a half years. Data were lacking or insufficient on the size and location of the incision and on the technique used for specimen extraction.

There is a lack of evidence on the risk of developing IH in minimally invasive gynaecological surgery. Given the increasing use of minimally invasive surgical techniques, there is a pressing need for high-quality research on the prevalence and risk factors of IH, as well as on interventions aimed at mitigating this risk.

This review reveals a lack of high-quality evidence and consistent reporting on factors influencing IH after specimen extraction in minimally invasive gynaecological surgery.