AI Article Synopsis
- The study aimed to find the best hysterectomy method for large uteri, focusing on the risks and complications associated with different surgical approaches for benign conditions.
- Researchers analyzed 25 studies, including various types of trials, and found that total vaginal hysterectomy generally had shorter operating times and lower risks of ureteral injury compared to laparoscopic methods.
- Results indicated that total vaginal hysterectomy is preferable for reducing hospital stay and risk of complications, while robotic-assisted methods showed a lower likelihood of blood transfusion compared to traditional abdominal approaches.
Article Abstract
Objective: To identify the optimal hysterectomy approach for large uteri in gynecologic surgery for benign indications from a perioperative morbidity standpoint.
Data Sources: PubMed and Embase databases were searched from inception through September 19, 2022. Meta-analyses were conducted as feasible.
Methods Of Study Selection: This review included studies that compared routes of hysterectomy with or without bilateral salpingo-oophorectomy for large uteri (12 weeks or more or 250 g or more) and excluded studies with any concurrent surgery for pelvic organ prolapse, incontinence, gynecologic malignancy, or any obstetric indication for hysterectomy.
Tabulation, Integration, And Results: The review included 25 studies comprising nine randomized trials, two prospective, and 14 retrospective nonrandomized comparative studies. Studies were at high risk of bias. There was lower operative time for total vaginal hysterectomy compared with laparoscopically assisted vaginal hysterectomy (LAVH) (mean difference 39 minutes, 95% CI, 18-60) and total vaginal hysterectomy compared with total laparoscopic hysterectomy (mean difference 50 minutes, 95% CI, 29-70). Total laparoscopic hysterectomy was associated with much greater risk of ureteral injury compared with total vaginal hysterectomy (odds ratio 7.54, 95% CI, 2.52-22.58). There were no significant differences in bowel injury rates between groups. There were no differences in length of stay among the laparoscopic approaches. For LAVH compared with total vaginal hysterectomy, randomized controlled trials favored total vaginal hysterectomy for length of stay. When rates of blood transfusion were compared between these abdominal hysterectomy and robotic-assisted total hysterectomy routes, abdominal hysterectomy was associated with a sixfold greater risk of transfusion than robotic-assisted total hysterectomy (6.31, 95% CI, 1.07-37.32). Similarly, single studies comparing robotic-assisted total hysterectomy with LAVH, total laparoscopic hysterectomy, or total vaginal hysterectomy all favored robotic-assisted total hysterectomy for reduced blood loss.
Conclusion: Minimally invasive routes are safe and effective and have few complications. Minimally invasive approach (vaginal, laparoscopic, or robotic) results in lower blood loss and shorter length of stay, whereas the abdominal route has a shorter operative time.
Systematic Review Registration: PROSPERO, CRD42021233300.
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| http://dx.doi.org/10.1097/AOG.0000000000005607 | DOI Listing |
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