Objective: To assess real-world usage patterns, regulatory compliance, and perceived safety concerns related to tissue containment systems (TCSs) and tissue retrieval bags (TRBs) in laparoscopic hysterectomy and myomectomy among first-year fellows in minimally invasive gynecologic surgery (FMIGS).

Design: Cross-sectional electronic survey.

Setting: U.S.-based academic centers participating in FMIGS.

Participants: First-year FMIGS fellows. No patient data was collected.

Interventions: None.

Results: Of 50 eligible fellows, 31 completed the survey (62% response rate). Abdominal manual morcellation (AMM) was the predominant extraction technique, with 42% using it in over 80% of cases. Transvaginal morcellation (TVM) was used in fewer than 20% of cases by 65%, and power morcellation (PM) was rarely used (3%).

Although 77% of respondents reported awareness of the regulatory distinction between FDA-cleared containment systems and offlabel retrieval bags, 45% usually or always used the latter. The Alexis Contained Extraction System (Applied Medical) was the most frequently used containment device (90%), but 81% of users did not consistently apply the included protective components. Notably, 35% of respondents estimated that punctures occurred in 30% or more of cases, regardless of bag type. Cost was cited more often than regulatory concerns as a barrier to use (61% vs. 29%).

Conclusion: Laparoscopic procedures involving AMM and the use of containment systems are increasingly common. However, high estimated puncture rates, frequent off-label usage, and incomplete protocol adherence suggest the need for greater regulatory clarity, improved device training, and broader access to purpose-built containment solutions.