Comparison of in-bag morcellation and open retrieval techniques in laparoscopic simple nephrectomy

Introduction: The method of specimen retrieval following laparoscopic nephrectomy can influence postoperative outcomes. Morcellation, once limited by technical shortcomings, has improved significantly with the advent of modern devices. Objectives: This study compares in-bag morcellation using new-age tools with open specimen retrieval. Methods: A prospective comparative study was conducted in our tertiary urology institute from August 2023 to September 2024. Fifty patients undergoing laparoscopic simple nephrectomy for benign non-functioning kidneys were assigned to open retrieval ( n = 25) or in-bag morcellation ( n = 25). Primary outcomes included incision-related complications. Secondary outcomes assessed were postoperative complications, opioid requirement, hospital stay, operative duration, and cosmetic satisfaction. Results: Incision-related complications occurred in 6/25 (24%) patients in the open retrieval group and none in the morcellation group ( p = 0.022). Operative times were similar between groups (200.68 vs 193.08 min, p = 0.173). Opioid use was required in the open retrieval group (48%), but none in the morcellation group required opioids ( p < 0.001). Most of the patients in the morcellation group were discharged within 3 days (96%) when compared with the open retrieval group (64%) ( p = 0.011). Fewer postoperative complications were noted in the morcellation group (4%) when compared with the open retrieval group (28%). Patient satisfaction scores were higher in the morcellation group (17.0 ± 2.11) than in the open retrieval group (15.0 ± 5.75) ( p = 0.028). Conclusions: In this study, in-bag morcellation was associated with improved short-term postoperative outcomes and higher patient satisfaction compared with open specimen retrieval. Larger multicentre studies with longer follow-up are required to confirm these findings.