The major concerns of the author are microscopic leakage of the plastic bag, that we indeed have not excluded, and the morcellation of tissue with a high probability of cancer. We share these concerns, but as demonstrated in our video, we observe vaginal morcellation by simultaneous laparoscopy. The coring morcellation procedure always produces some fluid as residue, which accumulates in the bag. After extraction we always test the bag for leakage by controlling the tightness of the bag. But we admit that a very low risk of microscopic leakage can not entirely be excluded.

As stated in our manuscript and in contrast to some recent reports, we strictly exclude vaginal in-bag morcellation in patients at high risk for cancer or with already confirmed malignancy. We recommend it as a risk-reducing procedure in patients with uncertain uterine mass, and in these cases our data seem strong enough to recommend it as clinical routine to avoid laparotomy. Since incidental morcellated uterine malignancies are rare, we appreciate any independent report in the future about the experience of our described method.