This study evaluates the feasibility, safety, and efficiency of transvaginal in-bag electromechanical morcellation for specimen extraction in patients undergoing total laparoscopic hysterectomy for large uteri.

This single-center prospective study investigates a novel transvaginal specimen extraction technique using a sealed containment bag combined with electromechanical morcellation. The procedure aims to improve specimen extraction efficiency while preventing tissue dissemination during laparoscopic hysterectomy for uteri larger than 12-week gestational size.

Inclusion Criteria:

Female patients aged 38 to 52 years

Planned to undergo total laparoscopic hysterectomy

Uterine size greater than 12 weeks gestational size based on preoperative imaging

Eligible for transvaginal specimen extraction

Able and willing to provide written informed consent

Exclusion Criteria:

Advanced gynecologic malignancy

Severe pelvic obliteration preventing transvaginal access

Contraindication to laparoscopic surgery

Pregnancy

Inability or unwillingness to provide informed consent

Women undergoing total laparoscopic hysterectomy for enlarged uteri at a single tertiary medical center. Participants include patients with uterine fibroids or adenomyosis and uterine size greater than 12 weeks gestational size who are suitable for transvaginal specimen extraction.

Individual participant data will not be shared due to institutional data protection policies and the potential risk of participant identification in a single-center surgical study.