Minimally invasive specimen retrieval in gynecology: current techniques, innovations, and clinical considerations

The purpose of this review is to provide an updated summary on the practice of specimen extraction during minimally invasive gynecological surgery, including the location of extraction site, mode of extraction, the choice of equipment, and key clinical considerations.

Specimen tissue extraction during minimally invasive gynecologic surgery can be performed vaginally or abdominally, although neither has been proven to be superior. Current practice and training trends suggest declining use of the vaginal route for specimen extraction, with increasing preference for transabdominal manual morcellation. The site of transabdominal specimen extraction, either umbilical or suprapubic, does not appear to significantly affect postoperative pain outcomes. Power morcellators are infrequently used among surgeons, especially in the USA, and rarely used among trainees. Specimen retrieval bags are often utilized off label as tissue containment systems. Newer specimen retrieval systems have additional protective features to avoid injury and the spread of tissue. Research utilizing minimally invasive surgery and extraction techniques for known gynecologic malignancy is emerging.

Regulations, strategies, training, and equipment for minimally invasive specimen retrieval in gynecological surgery continue to evolve over the years. More high-quality research is needed to elucidate the optimal route, technique, and containment systems to facilitate safe and efficient surgery.