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Abordajes quirúrgicos de la histerectomía para las enfermedades ginecológicas benignas

This is not the most recent version

Appendices

Appendix 1. MDSG search

MDSG Specialised Register SS for NJ473 11.11.10

Keywords CONTAINS "Hysterectomy" or Title CONTAINS "Hysterectomy"

AND

Keywords CONTAINS "Hysterectomy,abdominal" or "Hysterectomy, Vaginal" or "hysterectomy ‐laparoscopic" or "hysterectomy, laparoscopically assisted vaginal" or "Hysterectomy, subtotal" or "hysterectomy techniques" or "laparoscopic assisted vaginal hysterectomy" or "laparoscopic hysterectomy" or "LAVH" or Title CONTAINS "Hysterectomy,abdominal" or "Hysterectomy, Vaginal" or "hysterectomy ‐laparoscopic" or "hysterectomy, laparoscopically assisted vaginal" or "Hysterectomy, subtotal" or "hysterectomy techniques" or "laparoscopic assisted vaginal hysterectomy" or "laparoscopic hysterectomy" or "LAVH" or "TVH" or "TLH" or "vaginal hysterectomy"or "abdominal hysterectomy"or "abdominal myomectomy"or"laparoscopic"or"laparoscopic procedure"or"laparoscopic surgical treatment"or"laparoscopically assisted hysterectomy"or"laparoscopically assisted vaginal hysterectomy"or"laparoscopy"or "laparotomy"or"mini‐laparoscopy"or "mini‐laparotomy"or "abdominal hysterectomy"

Appendix 2. CENTRAL search

Cochrane Central Register of Controlled Trials (CENTRAL) in all fields (on Ovid platform)

1. Hysterectomy
2. Abdominal
3. Vaginal
4. Laparoscopic assisted
5. Laparo‐vaginal
6. Laparoscopic
7. 1 and 2 or 3 or 4 or 5 or 6

Appendix 3. MEDLINE search

Ovid MEDLINE(R) (1946 to 2014 week 32)

Search strategy:

1 exp HYSTERECTOMY/ (24605)
2 hysterectom$.tw. (26883)
3 1 or 2 (37348)
4 abdom$.tw. (253636)
5 vaginal$.tw. (74351)
6 (lap$ adj assist$).tw. (3843)
7 (lap$ adj5 vaginal$).tw. (1692)
8 LAVH.tw. (324)
9 LVH.tw. (3897)
10 (Ah or Vh or Lh).tw. (62452)
11 TLH.tw. (309)
12 exp Laparoscopy/ (69937)
13 Laparoscop$.tw. (84412)
14 route$.tw. (121604)
15 technique$.tw. (1094816)
16 approach$.tw. (1056843)
17 exp Laparotomy/ (15750)
18 laparotom$.tw. (38835)
19 minilaparotom$.tw. (927)
20 or/4‐19 (2520921)
21 3 and 20 (16470)
22 randomized controlled trial.pt. (385723)
23 controlled clinical trial.pt. (89662)
24 randomized.ab. (305899)
25 placebo.tw. (162963)
26 clinical trials as topic.sh. (172008)
27 randomly.ab. (220260)
28 trial.ti. (131972)
29 (crossover or cross‐over or cross over).tw. (62251)
30 or/22‐29 (950838)
31 exp animals/ not humans.sh. (3994784)
32 30 not 31 (876347)
33 21 and 32 (1715)
34 2014$.ed. (619882)
35 2014$.dp. (613080)
36 34 or 35 (1063755)
37 33 and 36 (106)

Appendix 4. EMBASE search

EMBASE (1980 to 2014 Week 32)

1 Controlled study/ or randomised controlled trial/
2 double blind procedure/
3 single blind procedure/
4 crossover procedure/
5 drug comparison/
6 placebo/
7 random$.ti,ab,hw,tn,mf.
8 latin square.ti,ab,hw,tn,mf.
9 crossover.ti,ab,hw,tn,mf.
10 cross‐over.ti,ab,hw,tn,mf.
11 placebo$.ti,ab,hw,tn,mf.
12 ((doubl$ or singl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).ti,ab,hw,tn,mf.
13 (comparative adj5 trial$).ti,ab,hw,tn,mf.
14 (clinical adj5 trial$).ti,ab,hw,tn,mf.
15 or/1‐14
16 nonhuman/
17 animal/ not (human/ and animal/)
18 or/16‐17
19 15 not 18
20 exp HYSTERECTOMY/
21 hysterectom$.tw.
22 20 or 21
23 abdom$.tw.
24 vaginal$.tw.
25 (Lap$ adj Assist$).tw.
26 (Lap$ adj Vaginal$).tw.
27 LAVH.tw.
28 LH.tw.
29 or/23‐28
30 exp Surgical Technique/
31 route$.tw.
32 technique$.tw.
33 approach$.tw.
34 or/30‐33
35 22 and 29
36 34 and 35
37 19 and 36

Appendix 5. CINAHL search

CINAHL search strategy for NJ473 28.01.14

# Query Results

S38 S22 AND S36

S37 S22 AND S36

S36 S23 OR S24 or S25 or S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34 OR S35

S35 TX allocat* random*

S34 (MH "Quantitative Studies")

S33 (MH "Placebos")

S32 TX placebo*

S31 TX random* allocat*

S30 (MH "Random Assignment")

S29 TX randomi* control* trial*

S28 TX ( (singl* n1 blind*) or (singl* n1 mask*) ) or TX ( (doubl* n1 blind*) or (doubl* n1 mask*) ) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*) ) or TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

S27 TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

S26 TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )

S25 TX clinic* n1 trial*

S24 PT Clinical trial

S23 (MH "Clinical Trials+")

S22 S3 AND S21

S21 S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20

S20 TX minilaparotom*

S19 TX laparotom*

S18 (MM "Laparotomy")

S17 TX approach*

S16 TX technique*

S15 TX route*

S14 TX Laparoscop*

S13 (MM "Laparoscopy")

S12 TX TLH

S11 TX (Ah or Vh or Lh)

S10 TX LVH

S9 TX LAVH

S8 TX (lap* N2 vagina*)

S7 TX (lap* N2 assist*)

S6 TX vagina*

S5 (MM "Hysterectomy, Vaginal")

S4 TX abdomin*

S3 S1 OR S2

S2 TX Hysterectom*

S1 (MH "Hysterectomy+")

Appendix 6. Biological abstracts search

Biological Abstracts (1969 to August 2008, not included in searches beyond 2008)

1 exp HYSTERECTOMY/ (0)
2 hysterectom$.tw. (10663)
3 1 or 2 (10663)
4 abdom$.tw. (149794)
5 vaginal$.tw. (31662)
6 (lap$ adj assist$).tw. (691)
7 (lap$ adj5 vaginal$).tw. (540)
8 LAVH.tw. (71)
9 LVH.tw. (1654)
10 Laparoscop$.tw. (16487)
11 route$.tw. (373620)
12 technique$.tw. (3259392)
13 approach$.tw. (354093)
14 laparo$.tw. (29111)
15 or/4‐14 (3796162)
16 3 and 15 (7312)
17 limit 16 to yr="2007 ‐ 2008" (529)
18 from 17 keep 1‐529 (529)

Appendix 7. PsycINFO search

PsycINFO <1806 to August Week 1 2014>

Search strategy:

1 exp Hysterectomy/ (384)
2 hysterectom$.tw. (677)
3 or/1‐2 (698)
4 abdom$.tw. (4874)
5 vaginal$.tw. (3769)
6 (lap$ adj assist$).tw. (6)
7 (lap$ adj5 vaginal$).tw. (10)
8 LAVH.tw. (2)
9 LVH.tw. (23)
10 Laparoscop$.tw. (304)
11 route$.tw. (11033)
12 technique$.tw. (151513)
13 approach$.tw. (369519)
14 or/4‐13 (509044)
15 3 and 14 (149)
16 limit 15 to yr="2014 ‐Current" (2)

Appendix 8. Clinical Trials Register

1. Hysterectomy
2. Abdominal
3. Vaginal
4. Laparoscopic assisted
5. Laparo‐vaginal
6. Laparoscopic
7. 1 and 2 or 3 or 4 or 5 or 6

Appendix 9. Data extraction

  • Trial characteristics

    • Method of randomisation, in order of preference, as follows:

      • third party randomisation, for example by pharmacy, computer, or telephone;

      • true randomisation by carer, for example by opaque numbered envelope or register;

      • not stated.

    • Study design:

      • blinding;

      • duration of follow‐up;

      • type of follow‐up.

    • Size of study:

      • number of women recruited;

      • number of women randomised;

      • number of women excluded;

      • number of women withdrawn and lost to follow‐up;

      • number of women analysed.

    • Study setting:

      • single centre or multicentre;

      • location;

      • timing and duration;

      • source of funding stated or not.

    • Analyses:

      • whether a power calculation was performed and adhered to;

      • whether 'intention‐to‐treat' analysis was performed by authors, was possible from the data but not performed by authors, not possible or uncertain.

    • Criteria for hysterectomy:

      • indications specified;

      • data broken down by indications for hysterectomy.

  • Characteristics of the study participants

    • Baseline characteristics:

      • age;

      • parity;

      • indication for hysterectomy;

      • investigative work up, for example pelvic ultrasound scan, endometrial sampling;

      • previous treatments;

      • exclusion criteria.

    • Treatment characteristics:

      • pre‐operative preparation, for example pre‐operative medical treatment;

      • level of training of surgeons.

  • Interventions

    • Approach to hysterectomy, percentage of patients having subtotal hysterectomy

    • Subcategory in case of LH (i.e. LAVH, LH(a) and TLH)

    • Use of technique to support the vaginal vault

    • Proportion undergoing bilateral elective oophorectomy versus ovarian conservation

    • Other strategies to reduce the likelihood of complications

    • Absence of co‐interventions in treatment and control groups

    • If the trial compared a surgical approach performed by one (group of) surgeon(s) with another surgical approach performed by a second (group of) surgeon(s)

  • Outcomes

    • Primary outcomes:

    • 1. Return to normal activities

    • 2. Satisfaction and quality of life

    • 3. Intra‐operative visceral injury: bladder injury, ureter injury, urinary tract (bladder or ureter) injury, bowel injury, vascular injury

    • 4. Major long‐term complications: fistula, pelvi‐abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition (prolapse), sexual dysfunction

    • Secondary outcomes:

    • 5. Operation time

    • 6. Other intra‐operative complication: estimated blood loss, (sequelae of) bleeding, including substantial bleeding, haemoglobin or haematocrit drop, transfusion, pelvic haematoma, unintended laparotomy for approaches not involving routine laparotomy

    • 7. Short‐term outcomes and complications: length of hospital stay, infections: vaginal cuff, abdominal wall or wound, urinary tract infection, chest infection, febrile episodes or unspecified infections, thromboembolism, perioperative mortality, postoperative ileus, wound dehiscence, pain scales and pain relief

    • 8. Costs

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.

'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 3

'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

Forest plot of comparison: 1 VH versus AH, outcome: 1.1 Return to normal activities (days).
Figures and Tables -
Figure 4

Forest plot of comparison: 1 VH versus AH, outcome: 1.1 Return to normal activities (days).

Forest plot of comparison: 2 LH versus AH, outcome: 2.1 Return to normal activities (days).
Figures and Tables -
Figure 5

Forest plot of comparison: 2 LH versus AH, outcome: 2.1 Return to normal activities (days).

Forest plot of comparison: 3 LH versus VH, outcome: 3.1 Return to normal activities (days).
Figures and Tables -
Figure 6

Forest plot of comparison: 3 LH versus VH, outcome: 3.1 Return to normal activities (days).

Forest plot of comparison: 4 RH versus LH, outcome: 4.1 Return to normal activities (days).
Figures and Tables -
Figure 7

Forest plot of comparison: 4 RH versus LH, outcome: 4.1 Return to normal activities (days).

Comparison 1 VH versus AH, Outcome 1 Return to normal activities (days).
Figures and Tables -
Analysis 1.1

Comparison 1 VH versus AH, Outcome 1 Return to normal activities (days).

Comparison 1 VH versus AH, Outcome 2 Long‐term outcomes: satisfaction (dichotomous).
Figures and Tables -
Analysis 1.2

Comparison 1 VH versus AH, Outcome 2 Long‐term outcomes: satisfaction (dichotomous).

Comparison 1 VH versus AH, Outcome 3 Intraoperative visceral injury (dichotomous).
Figures and Tables -
Analysis 1.3

Comparison 1 VH versus AH, Outcome 3 Intraoperative visceral injury (dichotomous).

Comparison 1 VH versus AH, Outcome 4 Long‐term complications (dichotomous).
Figures and Tables -
Analysis 1.4

Comparison 1 VH versus AH, Outcome 4 Long‐term complications (dichotomous).

Comparison 1 VH versus AH, Outcome 5 Operation time (mins).
Figures and Tables -
Analysis 1.5

Comparison 1 VH versus AH, Outcome 5 Operation time (mins).

Comparison 1 VH versus AH, Outcome 6 Short‐term outcomes (dichotomous).
Figures and Tables -
Analysis 1.6

Comparison 1 VH versus AH, Outcome 6 Short‐term outcomes (dichotomous).

Comparison 1 VH versus AH, Outcome 7 Length of hospital stay (days).
Figures and Tables -
Analysis 1.7

Comparison 1 VH versus AH, Outcome 7 Length of hospital stay (days).

Study

VH

AH

Comments

Quality of life (descriptive data)

Silva Filho 2006

Questionnaire SF‐36. Only data from functional capacity, physical aspect and pain are presented. A high score is a better quality of life

n = 30
1 month after surgery, response rate 100%

n = 30
1 month after surgery, response rate 100%

Functional capacity: VH mean = 95, IQ‐range = 75 to 100. AH mean = 72.5, IQ‐range = 55 to 90

Physical aspect: VH mean = 100, IQ‐range = 25 to 100. AH mean = 37.5, IQ‐range = 0 to 100

Pain: VH mean = 84, IQ‐range = 59.2 to 100. AH mean = 51, IQ‐range = 41 to 65.

A higher rate of patients in VH would choose the same therapeutic modality (90 % versus 65.5 %, P value = 0.021)

Operation time (descriptive data)

Hwang 2002

With 2nd procedure:
median = 93
range = 80 to 110
n = 3
Without 2nd procedure:
median = 74
range = 40 to 120
n = 27

With 2nd procedure:
median = 117
range = 90 to 190
n = 8
Without 2nd procedure:
median = 98
range = 85 to 150
n = 22

Not tested separately

Miskry 2003

Mean 68.8 (range 30 to 180) mins
n = 18

Mean 68.2 (range 45 to 174) mins
n = 18

Ribeiro 2003

Mean 78 mins
n = 20

Mean 109 mins
n = 20

No measure of spread stated

Length of hospital stay (descriptive data)

Hwang 2002

n = 30
median = 4.7 days
range (3 to 7)

n = 30
median = 5 days
range (4 to 8)

Not tested separately

Ribeiro 2003

n = 20
All went home on second postoperative day

n = 20
All went home on third postoperative day

Figures and Tables -
Analysis 1.8

Comparison 1 VH versus AH, Outcome 8 All outcomes, descriptive data.

Comparison 2 LH versus AH, Outcome 1 Return to normal activities (days).
Figures and Tables -
Analysis 2.1

Comparison 2 LH versus AH, Outcome 1 Return to normal activities (days).

Comparison 2 LH versus AH, Outcome 2 Satisfaction.
Figures and Tables -
Analysis 2.2

Comparison 2 LH versus AH, Outcome 2 Satisfaction.

Comparison 2 LH versus AH, Outcome 3 Bladder injury.
Figures and Tables -
Analysis 2.3

Comparison 2 LH versus AH, Outcome 3 Bladder injury.

Comparison 2 LH versus AH, Outcome 4 Ureter injury.
Figures and Tables -
Analysis 2.4

Comparison 2 LH versus AH, Outcome 4 Ureter injury.

Comparison 2 LH versus AH, Outcome 5 Urinary tract (bladder or ureter) injury.
Figures and Tables -
Analysis 2.5

Comparison 2 LH versus AH, Outcome 5 Urinary tract (bladder or ureter) injury.

Comparison 2 LH versus AH, Outcome 6 Bowel injury.
Figures and Tables -
Analysis 2.6

Comparison 2 LH versus AH, Outcome 6 Bowel injury.

Comparison 2 LH versus AH, Outcome 7 Vascular injury.
Figures and Tables -
Analysis 2.7

Comparison 2 LH versus AH, Outcome 7 Vascular injury.

Comparison 2 LH versus AH, Outcome 8 Fistula.
Figures and Tables -
Analysis 2.8

Comparison 2 LH versus AH, Outcome 8 Fistula.

Comparison 2 LH versus AH, Outcome 9 Urinary dysfunction.
Figures and Tables -
Analysis 2.9

Comparison 2 LH versus AH, Outcome 9 Urinary dysfunction.

Comparison 2 LH versus AH, Outcome 10 Operation time (mins).
Figures and Tables -
Analysis 2.10

Comparison 2 LH versus AH, Outcome 10 Operation time (mins).

Comparison 2 LH versus AH, Outcome 11 Bleeding.
Figures and Tables -
Analysis 2.11

Comparison 2 LH versus AH, Outcome 11 Bleeding.

Comparison 2 LH versus AH, Outcome 12 Transfusion.
Figures and Tables -
Analysis 2.12

Comparison 2 LH versus AH, Outcome 12 Transfusion.

Comparison 2 LH versus AH, Outcome 13 Pelvic haematoma.
Figures and Tables -
Analysis 2.13

Comparison 2 LH versus AH, Outcome 13 Pelvic haematoma.

Comparison 2 LH versus AH, Outcome 14 Unintended laparotomy.
Figures and Tables -
Analysis 2.14

Comparison 2 LH versus AH, Outcome 14 Unintended laparotomy.

Comparison 2 LH versus AH, Outcome 15 Length of hospital stay (days).
Figures and Tables -
Analysis 2.15

Comparison 2 LH versus AH, Outcome 15 Length of hospital stay (days).

Comparison 2 LH versus AH, Outcome 16 Vaginal cuff infection.
Figures and Tables -
Analysis 2.16

Comparison 2 LH versus AH, Outcome 16 Vaginal cuff infection.

Comparison 2 LH versus AH, Outcome 17 Wound/abdominal wall infection.
Figures and Tables -
Analysis 2.17

Comparison 2 LH versus AH, Outcome 17 Wound/abdominal wall infection.

Comparison 2 LH versus AH, Outcome 18 Urinary tract infection.
Figures and Tables -
Analysis 2.18

Comparison 2 LH versus AH, Outcome 18 Urinary tract infection.

Comparison 2 LH versus AH, Outcome 19 Chest infection.
Figures and Tables -
Analysis 2.19

Comparison 2 LH versus AH, Outcome 19 Chest infection.

Comparison 2 LH versus AH, Outcome 20 Febrile episodes or unspecified infection.
Figures and Tables -
Analysis 2.20

Comparison 2 LH versus AH, Outcome 20 Febrile episodes or unspecified infection.

Comparison 2 LH versus AH, Outcome 21 Thromboembolism.
Figures and Tables -
Analysis 2.21

Comparison 2 LH versus AH, Outcome 21 Thromboembolism.

Comparison 2 LH versus AH, Outcome 22 Wound dehiscence.
Figures and Tables -
Analysis 2.22

Comparison 2 LH versus AH, Outcome 22 Wound dehiscence.

Study

LH

AH

Comments

Langebrekke 1996

n = 46
median = 19.5 days
range (0 to 140)

n = 54
median = 36.5 days
range (23 to 259)

P value < 0.001
Wilcoxon rank‐sum test

Persson 2006

n = 63
median = 26 days
range (3 to 86)

n = 56
median = 33.5 days
range (14 to 61)

P value = 0.0081

Raju 1994

n = 40
median = 21 days
range = (7 to 35)

n = 40
median = 42 days
range (21 to 67)

P value < 0.0001
Mann‐Whitney U test

Schutz 2002

n = 28
median = 42 days

n = 20
median = 42 days

Figures and Tables -
Analysis 2.23

Comparison 2 LH versus AH, Outcome 23 Return to normal activities (descriptive data).

Study

Description

LH

AH

Comments

Garry 2004

Questionnaire assessment of sexual activity, body image (BIS) and health status (SF‐12) before and after surgery (6 weeks, 4 months and 1 year)
SF‐12 scores: difference at each time point (high score = better quality of life).
Body Image Scale: difference at each time point (low score = a better body image)

SF scores
PHYSICAL COMPONENT SUMMARY (PCS‐12)
Baseline (n = 447)
Mean = 44.9, SD = 11.7
6 weeks (n = 301)
Mean = 46.8, SD = 10.1
4 months (n = 304)
Mean = 52.6, SD = 8.6
1 year (n = 330)
Mean = 53.6, SD = 8.4

MENTAL COMPONENT SUMMARY (MCS‐12)
Baseline (n = 447
Mean = 45.8, SD = 11.7
6 weeks (n = 301)
Mean = 50, SD = 11.4
4 months (n = 304)
Mean = 50.9, SD = 10.5
1 year (n = 330)
Mean = 50.7, SD = 10.7

Body Image Scale
Baseline (n = 540)
Mean = 8.8, SD = 8.1
6 weeks (n = 357)
Mean = 3.7, SD = 4.9
4 months (n = 346)
Mean = 3.3, SD = 4.9
1 year (n = 387)
Mean = 3.4, SD = 5.2

SF scores
PHYSICAL COMPONENT SUMMARY (PCS‐12)
Baseline (n = 221)
Mean = 45.6, SD = 11.5
6 weeks (n = 148)
Mean = 41.7, SD = 9.7
4 months (n = 134)
Mean = 51.6, SD = 8.6
1 year (n = 148)
Mean = 52.7, SD = 9.3

MENTAL COMPONENT SUMMARY (MCS‐12)
Baseline (n = 221)
Mean = 45.3, SD = 11.3
6 weeks (n = 148)
Mean = 51.9, SD = 10.8
4 months (n = 134)
Mean = 51.8, SD = 9.5
1 year (n = 148)
Mean = 51.9, SD = 10.2

Body Image Scale
Baseline (n = 270)
Mean = 9, SD = 7.9
6 weeks (n = 172)
Mean = 5.2, SD = 5.9
4 months (n = 159)
Mean = 4.4, SD = 6.3
1 year (n = 168)
Mean = 4.1, SD = 5.7

SF scores
PCS‐12
Baseline: difference CI = 0.6 (‐1.2 to 2.5)
6 weeks: difference CI = ‐5.1 (‐7.1 to ‐3.2). P value < 0.0001
4 months: difference CI = ‐1.0 (‐2.8 to 0.7). P value = 0.25
1 year = difference in CI = ‐0.9 (‐2.5 to 0.8). P value = 0.32

MCS‐12
Baseline: difference in CI = ‐0.5 (‐2.4 to 1.4)
6 weeks: difference in CI = 1.8 (‐0.4 to 4). P value = 0.11
4 months: difference in CI = 0.8 (‐1.3 to 2.9). P value = 0.44
1 year: difference in CI = 1.1 (‐0.9 to 3.2)
P value = 0.27

Body Image Scale
Baseline: difference in CI = 0.2 (‐0.9 to 1.4)
6 weeks: difference in CI = 1.5 (0.5 to 2.4). P value = 0.005
4 months: difference in CI = 1.1 (0.06 to 2.1). P value = 0.06
1 year: difference in CI = 0.7 (‐0.2 to 1.7). P value = 0.13

Both aLH and AH groups had improvements in the Physical and Mental components of SF12 and Body Image Scale. These were maintained and improved at 12 months. Significant difference in PCS‐12 at 6 weeks between aLH and AH and highly significant differences in BIS at 6 weeks, but this difference did not persist at 4 and 12 months

Kluivers 2007

Questionnaire RAND‐36. A high score is a better quality of life. Statistical analysis with use of linear mixed model to evaluate the differences between 2 and 12 weeks while accounting for baseline value

In Nieboer 2012, the same patients were evaluated with use of the same questionnaire 4 years after surgery

n = 27 at baseline
n = 27, 26, 26, 25 and 22 at 1, 2, 4, 6 and 12 weeks respectively

n = 23 at 4 years

n = 32 at baseline
n = 32, 32, 32, 31, 30 and 30 at 1, 2, 4, 6 and 12 weeks respectively

n = 26 at 4 years

Difference (95%CI) in favour of LH (the score range on subscales is 100, score range on total RAND‐36 scales is 800) over the first 12 weeks:
Physical functioning 7.8 (‐0.3; 15.9)
Social functioning 7.0 (‐1.8; 15.7)
Role physical 1.7 (‐7.7; 11.1)
Role emotional 1.5 (‐13.4; 16.5)
Mental health 3.6 (‐2.8; 9.9)
Vitality 12.0 (4.7; 19.3)
Bodily pain 8.4 (‐0.1; 17.4)
General health 0.0 (‐8.1; 8.1)
Total RAND‐36 49.6 (‐5.1; 104.2)
Only the difference in the subscale vitality was statistically significant

Analysis over 4 years follow up after surgery: Total RAND‐36 scores overall mean difference 50.4 points (95% confidence interval 1.0 –99.7) in favour of LH. Statistically significant higher scores were also found on the domains physical role functioning, social role functioning and vitality

Lumsden 2000

EuroQol Health Questionnaire used to measure women's evaluation of their health state post surgery (1, 6 and 12 months after surgery). Use of a visual analogue thermometer (0 is worst imaginable health state and 100 is best imaginable health state).

1 month (post‐op minus pre‐op): n = 74. Mean = 7, SD = 24.1. Median = 10, range (‐50 to 50)

6 months: n = 62. Mean = 11.3, SD = 23.9. Median = 15, range (‐50 to 60)
1 year: n = 43. Mean = 12.6, SD = 25. Median = 14, range (‐40 to 73)

1 month: n = 76. Mean = 6.8, SD = 19.2. Median = 8, range (‐50 to 60).
6 months: n = 61. Mean = 14.9, SD = 16.7 Median = 15, range (‐20 to 60)
1 year: n = 47. Mean = 15.9, SD = 21. Median = 15, range (‐40 to 60)

Mean difference: 1 month: ‐1.6 (‐7.2 to 6.9)
6 months: 3.7 (‐3.7 to 11).
1 year: 4.9 (‐6.7 to 12.8)

No evidence of a significant differences at 1 month, 6 months or 1 year after surgery

Olsson 1996

6 to 8 weeks after surgery participants were asked in an anonymous questionnaire if they considered the duration of their post‐operative stay adequate

9% of women in the LAVH group considered their time in hospital following surgery to be too short

17% of women in the AH group considered their time in hospital following surgery to be too short

Persson 2006

Questionnaires: Psychological General Wellbeing (PGWI), Women Health Questionnaire (WHQ), Spielberger Trait Anxiety Inventory (STAI) and Beck's Depression Inventory (BDI)
A higher score in the PGWB shows a higher degree of wellbeing, whereas in the WHQ, STAI, BDI a higher score shows the more undesirable outcomes. Assessment at baseline, and 5 weeks and 6 months postoperatively. Statistical analysis with the use of ANOVA for repeated measurements

Persson 2008 analysed wellbeing on a 0 to 100 VAS and stress coping ability

n = 63
PGWB: Baseline: mean = 96.7, SD = 17.9. 5 weeks: mean = 100.4, SD = 16.7. 6 months: mean = 104.7, SD = 18.5
WHQ: Baseline: mean = 64.9, SD = 13.9. 5 weeks: mean = 54.6, SD = 12.8. 6 months: mean = 55.0, SD = 14.4.
STAI: Baseline: mean = 35.6, SD = 9.1. 5 weeks: mean = 32.7, SD = 8.7. 6 months: mean = 33.6, SD = 10.2.
BDI: Baseline: mean = 6.6, SD = 5.8. 5 weeks: mean = 4.6, SD = 5.5. 6 months: mean = 5.3, SD = 6.8

n = 56
PGWB: Baseline: mean = 96.5, SD = 16.5. 5 weeks: mean = 102.1, SD = 16.4. 6 months: mean = 106.1, SD = 16.0
WHQ: Baseline: mean = 63.9, SD = 18.2. 5 weeks: mean = 54.3, SD = 17.1. 6 months: mean = 54.2, SD = 17.2.
STAI: Baseline: mean = 34.7, SD = 10.1. 5 weeks: mean = 31.7, SD = 10.6. 6 months: mean = 31.7, SD = 9.2.
BDI: Baseline: mean = 6.9, SD = 6.1. 5 weeks: mean = 5.0, SD = 6.5. 6 months: mean = 4.0, SD = 5.2

Main effect between groups: PGWB P value = 0.719, WHQ P value = 0.800, STAI P value = 0.418, BDI P value = 0.788. Main effect over time: PGWB P value < 0.0001, WHQ P value < 0.0001, STAI P value = 0.0002, BDI P value = 0.0002
Interaction: PGWB P value = 0.772, WHQ P value = 0.953, STAI P value = 0.762, BDI P value = 0.223

In Persson 2008: No significant difference was found in the day‐by‐day recovery of the general wellbeing between the operating methods. Stress coping ability did significantly influence the day‐by‐day recovery of general wellbeing

Figures and Tables -
Analysis 2.24

Comparison 2 LH versus AH, Outcome 24 Long‐term outcomes: quality of life (descriptive data).

Study

LH

AH

Comments

Falcone 1999

n = 23
median = 180 mins
range (139 to 225)

n = 21
median = 130 mins
range (97 to 155)

LH(a) vs AH
Wilcoxon rank‐sum test
P value < 0.001

Ferrari 2000

n = 31
median = 135 mins
range (115 to 173)

n = 31
median = 120 mins
range (98 to 123)

LAVH vs AH
P value = 0.001
Calculated from the first incision to closure of all wounds

Garry 2004

n = 584
median = 84 mins
range(10 to 325)

n = 292
median = 50 mins
range (19 to 155)

non‐categorisable LH vs AH
Calculated from first incision to last suture

Hwang 2002

With 2nd procedure
n = 13
median = 119
range (80 to 165)
Without 2nd procedure
n = 17
median = 109 mins
range (85 to 175)

With 2nd procedure
n = 8
median = 117 mins
range (90 to 190)
Without 2nd procedure
n = 22
Median = 98
Range (85 to 150)

LH(a) vs AH
Not tested separately

Langebrekke 1996

n = 46
median = 100 mins
range (50 to 153)

n = 54
median = 60.5 mins
range (22 to 105)

LH(a) vs AH

Muzii 2007

n = 40

median = 86 mins

range (60 to 120)

n = 41

median = 58 mins

range (45 to 75)

LAVH vs minilaparotomy AH

Persson 2006

n = 63
median = 99 mins
range (50 to 190)

n = 56
median = 64 mins
range (35 to 150)

LH(a) vs AH
P value < 0.0001 (students t test)

Raju 1994

n = 40
median = 100 mins
range (61‐180)

n = 40
median = 57 mins
range (25 to 151)

LAVH vs AH
P value < 0.0001
Mann‐Whitney U test
Calculated from first incision to time all wounds were closed, dressed and urinary catheter inserted

Ribeiro 2003

n = 20
Mean 119 mins
(no measure of spread reported)

n = 20
Mean 109 mins (no measure of spread reported)

TLH vs AH

Schutz 2002

n = 28
median = 133 mins
range (120 to 160)

n = 20
median = 132 mins
range (121 to 145)

LH(a) vs AH

Yuen 1998

n = 20
median = 95 mins
range (79 to 143)

n = 24
median = 105 mins
range (86 to 120)

LH(a) vs AH
Calculated from first surgical incision to time of last suture

Figures and Tables -
Analysis 2.25

Comparison 2 LH versus AH, Outcome 25 Operation time (descriptive data).

Study

LH

AH

Comments

Falcone 1999

n = 23
median = 1.5 days
range (1.0 to 2.3)

n = 21
median = 2.5 days
range (1.5 to 2.5)

P value = 0.038
Wilcoxon rank‐sum test

Ferrari 2000

n = 31
median = 3.8 days
range (3.8 to 4.0)

n = 31
median = 5.8 days
range (5.3 to 6.3)

P value < 0.001

Garry 2004

n = 584
median = 3 days
range (1 to 36)

n = 292
median = 4 days
range (1 to 36)

Hwang 2002

n = 30
median = 4.7 days
range (3 to 7)

n = 30
median = 5 days
range (4 to 8)

Not tested separately

Langebrekke 1996

n = 46
median = 2 days
range (0 to 5)

n = 54
median = 5 days
range (3 to 12)

P value < 0.001
Wilcoxon rank‐sum test

Muzii 2007

n = 40

median = 2 days

range (1 to 3)

n = 41

median = 3 days

range = (1 to 5)

P value = 0.53

Persson 2006

n = 63
median = 2 days
range (1 to 11)

n = 56
median = 3 days
range (2 to 7)

P value = 0.0006

In the same population (described in Persson 2008), duration of sick leave was associated with the occurrence of postoperative complications but not with stress‐coping ability

Raju 1994

n = 40
median = 3.5 days
range (1 to 6)

n = 40
median = 6 days
range (3 to 13)

P value < 0.0001
Mann‐Whitney U test

Ribeiro 2003

n = 20
all home on day 2

n = 20
all home on day 3

Schutz 2002

n = 28
median = 6.5 days
range (5 to 7)

n = 20
median = 10 days
range (8.25 to 11)

Yuen 1998

n = 20
median = 4 days
range (4 to 5)

n = 24
median = 6 days
range (5 to 9)

P value < 0.001
Mann‐Whitney U test

Figures and Tables -
Analysis 2.26

Comparison 2 LH versus AH, Outcome 26 Length of hospital stay (descriptive data).

Study

Description

LH

AH

Conclusions

Pain scales

Ellstrom 1998

Pain during rest and when coughing. 100 mm visual analogue scale, endpoints 'no pain' and 'worst pain possible'. Day 0, Day 1 (10am and 6pm) and Day 2

n = 40
DAY 0 (8pm). At rest: mean = 22, SD = 16. Coughing: mean = 29, SD = 20
DAY 1 (10am). At rest: mean = 17, SD = 16. Coughing: mean = 32, SD = 19. P value < 0.05
DAY 1 (6pm). At rest: mean = 24, SD = 20. Coughing: mean = 31, SD = 25
DAY 2 (10am). At rest: mean = 10, SD = 10. Coughing: mean = 15, SD = 14. P value < 0.01

n = 40
DAY 0 (8pm). At rest: mean = 36, SD = 26. Coughing: mean = 48, SD = 30
DAY 1 (10am). At rest: mean = 30, SD = 24. Coughing: mean = 53, SD = 30. P value < 0.05
DAY 1 (6pm). At rest: mean = 28, SD = 24. Coughing: mean = 52, SD = 28
DAY 2 (10am). At rest: mean = 20, SD = 22. Coughing: mean = 47, SD = 31
P value < 0.01

Lower pain score following LAVH compared to AH at 10am on 1st and 2nd day when coughing (P value < 0.05 and P value < 0.01 respectively). No significant difference with the pain scores at rest

Falcone 1999

Weekly visual analogue scales for pain (from "no pain" to "most severe pain". Reported in graph form

n = 22
Data portrayed in graph

n = 20
Data portrayed in graph

No significant difference in change over time (group by time interaction) between groups. No difference in mean pain scores over the postoperative interval (P value = 0.38). The number of weeks before a pain score of less than 1 was recorded was not significantly different between the 2 groups (P value = 0.95)

Garry 2004

Daily diary using a visual analogue scale, scored on day 0 (operation day), and days 2, 7 and 21. Analysis of covariance used to adjust pain scores over days 0 to 6 by the number of days that opiates were used

VH: n = 168
vLH: n = 336
Adjusted means: 3.1 VH and 3.5 vLH, mean difference of ‐0.3 (CI ‐0.7, 0.002), P value = 0.07)

AH: n = 292
aLH: n = 584
Adjusted means: 3.9 AH and 3.5 aLH, mean difference of 0.4 CI (0.09, 0.7, P value = 0.01)

A higher proportion of AH participants used opiates than aLH. AH is more painful than aLH and LH has a tendency to be less painful than vLH

Marana 1999

10‐point visual analogue scale. Evaluation of pain on postoperative days 1, 2 and 3

n = 58
DAY 0: mean = 40, SD = 1.2, P value < 0.001
DAY 1: mean = 5.2, SD = 2.6, P value < 0.05
DAY 2: mean = 2.3, SD = 2.3, P value < 0.001
DAY 3: mean 1.3, SD = 1.6, P value < 0.005

n = 58
DAY 0: mean = 5.9, SD = 2.3, P value < 0.001
DAY 1: mean = 6.3, SD = 1.6, P value < 0.05
DAY 2: mean = 4.4, SD = 1.9, P value < 0.001
DAY 3: mean = 2.8, SD = 2.3, P value < 0.005

Significant difference between 2 groups at 3 evaluations. Lower pain score following LAVH compared to AH

Muzii 2007

VAS scores (no further description)

Postoperative day 1 and 2

n = 40

Day 1 median = 2.8

Range (0 to 6)

Day 2 median = 0.8

Range (0 to 3.7)

n = 41

Day 1 median = 4.4

Range (2 to 6.2)

Day 2 median = 2.9

Range (2 to 5.5)

Day 1 P value < 0.05

Day 2 P value < 0.05

Olsson 1996

Visual analogue scale (range 0 to 7), 2 days after surgery

n = 71
Median = 3.6, P value < 0.05

n = 72
Median = 4.2, P value < 0.05

Postoperative pain 2 days after surgery was significantly less following LAVH compared to AH

Perino 1999

10‐point visual analogue scale, 0 = no pain to 10 = maximum pain. Assessed pain for 3 days after surgery

n = 51
DAY 1: mean = 4.1, SD = 1.2.
DAY 2: mean = 2.3, SD = 1.6.
DAY 3: mean 1.0, SD = 0.7.
P value < 0.001

n = 51
DAY 1: mean = 6.9, SD = 1.8. DAY 2: mean = 5.4, SD = 1.3.
DAY 3: mean = 3.1, SD = 0.9.
P value < 0.001

Participants who underwent LH had less intense postoperative pain than those in the AH group

Schutz 2002

10‐point visual analogue scale on days 1, 3 and 5. Pain index on 4th postoperative day (WHO scale)

n = 28
Pain index: median = 0 (0 to 1.75), P value < 0.05

n = 20
Pain index: median = 5 (4 to 6), P value < 0.05

Pain index was 0 on postoperative day 4 in the LH group and 5 in the AH group, LH was significantly less painful than AH

Postoperative analgesics

Falcone 1999

Length of time PCA pump was required (hours) and number of narcotic (oxycodone) or acetaminophen pills used in the hospital and after discharge was recorded

n = 23
PCA: Median = 22.1 hours, range (15.9 to 23.5), P value < 0.001
Number of narcotics (in hospital): median = 6, range (2.0 to 9.0), P value = 0.21. After discharge: median = 19.5, range(2 to 26), P value = 0.28.
Number of non‐narcotics (in hospital): median = 0, range (0 to 4), P value = 0.36. After discharge: median = 11, range (2 to 31), P value = 0.71

n = 21
PCA: Median = 36.7 hours, range (26.2 to 45), P value < 0.001
Number of narcotics (in hospital): Median = 8.5, range (4 to 10), P value = 0.21. After discharge: Median = 8, range (0 to 23.5), P value = 0.28
Number of non‐narcotics (in hospital): Median = 0, range (0 to 3.5), P value = 0.004. After discharge: median = 13.5, range (1 to 66), P value = 0.71

Participants in the LH group required less PCA time

Ferrari 2000

Analgesic requirement recorded daily for 3 groups (number who require analgesia for more than 24 hours after surgery):
1) Whole series of participants
2) Participants with uteri weighing under 500 g and 3) uteri weighing greater than 500 g

Group 1: n = 31
Median = 7, n% = 23, P value < 0.001
Group 2: n = 20. Median = 1, n% = 5, P value = 0.0001
Group 3: n = 11). Median = 6, n% = 55

Group 1: n = 31. Median = 24, n% = 77, P value < 0.001.
Group 2: n = 21. Median = 16, n% = 76, P value = 0.0001
Group 3: n = 10. Median = 8, n% = 80

LAVH was associated with a significantly lower administration of analgesics after the first 24 postoperative hours. Group 2, uteri weighing less than 500 g, LAVH was associated with less analgesic administration

Kluivers 2007

Number of participants receiving opioids during the first 3 days after surgery were recorded

n = 27
Use of opioids: 10

n = 32
Use of opioids: 22

Less women in LH versus AH group required opioids (P value < 0.01)

Langebrekke 1996

Number of participants receiving analgesics (parenterally, oral and rectal analgesics) during the hospital stay and 5 days postoperatively

n = 46
Data portrayed as bar chart

n = 54
Data portrayed as bar chart

The need for both kinds of analgesics was reduced in the LH group

Raju 1994

Duration of postoperative analgesia (days)

n = 40
Median = 6.6 days, range (0 to 23). P value < 0.0001

n = 40
Median = 13.3 days, range (2 to 38)
P value < 0.0001

Participants in the LAVH group required fewer days of analgesia than participants in the AH group

Summitt 1998

Use of intramuscular narcotics and oral pain medication

n = 34
26 of the 34 participants required IM narcotics on the day of surgery, P value = 0.018

n = 31
30 of the 31 participants required IM narcotics on the day of surgery, P value = 0.18

A statistically greater number of patients in the AH group required IM narcotics on the day of surgery compared to those in the LH group

Recovery from pain (days)

Raju 1994

Number of days until participants are free from pain

n = 40
Median = 13 days, range (6 to 34). P value < 0.0001

n = 40
Median = 26 days, range (10 to 46)
P value < 0.0001

Participants who had LAVH recovered from pain quicker than those who had AH

Figures and Tables -
Analysis 2.27

Comparison 2 LH versus AH, Outcome 27 Pain relief (descriptive data).

Study

Description

LH

AH

Comments

Ellstrom 1998

Analysis of cost over a period of 12 weeks, starting on the day the participant entered the hospital. Direct costs (hospital costs) and indirect costs (loss of production value) were analysed separately. Units of currency = Swedish crowns (SEK)

n = 38
Direct costs (average) = SEK 23,169
Indirect costs (average) = SEK 10,314

n = 38
Direct costs (average) = SEK22,780. Indirect costs (average) = SEK20,743.

The change in costs between LH and AH are negligible as approximately 50% of hospital costs are fixed costs

Falcone 1999

Hospital costs (amount a provider must pay for goods and services) were assessed through the hospital accounting system. The direct and indirect costs were calculated for each patient from 3 different components: operating room costs, anaesthesia costs and ward costs

n = 24
Difference in medians (LH‐AH): total hospital costs = USD 277 (CI ‐163 to 1097), P value = 0.21

n = 24
(see LH)

Total hospital costs were not significantly higher in the LH group than the AH group

Lumsden 2000

Single set of unit costs applied to each unit of resource to provide a NHS cost for each woman. 1997/98 prices

n = 95
Total cost (operation, inpatient stay and readmissions): median = GBP 2112, mean = GBP 2479
Cost excluding disposables: median = GBP 1740, mean = GBP 2173

n = 95
Total cost: median = £1667, mean = £1832. Cost excluding disposables: median = £1667, mean = £1832

AH had significantly lower total costs than LH, resulting principally from the difference in operation costs. When the cost of disposable equipment was removed, the difference was non‐significant

Raju 1994

Cost analysis of each type of procedure on the major points of difference between either operation: cost of disposable consumables and the comparative costs of postoperative lengths of stay in hospital

n = 40
Cost of operation (average) = GBP 225.
Cost of mean length of stay including operation time and cost of disposable instruments = GBP 1260

n = 40
Cost of operation (average) = GBP 30.
Cost of mean length of stay including operation time and cost of disposable instruments = GBP 1750

Summitt 1998

Hospital charges for both groups

n = 34
Mean = USD 8161, SD = 3600, range (3061 to 23,591). P value > 0.05

n = 31
Mean = USD 6974, SD = 2843, range (3183 to 16,086). P value > 0.05

Lack of a statistical difference in total hospital charges

Figures and Tables -
Analysis 2.28

Comparison 2 LH versus AH, Outcome 28 Cost (descriptive data).

Comparison 3 LH versus VH, Outcome 1 Return to normal activities (days).
Figures and Tables -
Analysis 3.1

Comparison 3 LH versus VH, Outcome 1 Return to normal activities (days).

Comparison 3 LH versus VH, Outcome 2 Ureter injury.
Figures and Tables -
Analysis 3.2

Comparison 3 LH versus VH, Outcome 2 Ureter injury.

Comparison 3 LH versus VH, Outcome 3 Bladder injury.
Figures and Tables -
Analysis 3.3

Comparison 3 LH versus VH, Outcome 3 Bladder injury.

Comparison 3 LH versus VH, Outcome 4 Urinary tract (bladder or ureter) injury.
Figures and Tables -
Analysis 3.4

Comparison 3 LH versus VH, Outcome 4 Urinary tract (bladder or ureter) injury.

Comparison 3 LH versus VH, Outcome 5 Bowel injury.
Figures and Tables -
Analysis 3.5

Comparison 3 LH versus VH, Outcome 5 Bowel injury.

Comparison 3 LH versus VH, Outcome 6 Vascular injury.
Figures and Tables -
Analysis 3.6

Comparison 3 LH versus VH, Outcome 6 Vascular injury.

Comparison 3 LH versus VH, Outcome 7 Fistula.
Figures and Tables -
Analysis 3.7

Comparison 3 LH versus VH, Outcome 7 Fistula.

Comparison 3 LH versus VH, Outcome 8 Urinary dysfunction.
Figures and Tables -
Analysis 3.8

Comparison 3 LH versus VH, Outcome 8 Urinary dysfunction.

Comparison 3 LH versus VH, Outcome 9 Operation time (mins).
Figures and Tables -
Analysis 3.9

Comparison 3 LH versus VH, Outcome 9 Operation time (mins).

Comparison 3 LH versus VH, Outcome 10 Bleeding.
Figures and Tables -
Analysis 3.10

Comparison 3 LH versus VH, Outcome 10 Bleeding.

Comparison 3 LH versus VH, Outcome 11 Transfusion.
Figures and Tables -
Analysis 3.11

Comparison 3 LH versus VH, Outcome 11 Transfusion.

Comparison 3 LH versus VH, Outcome 12 Pelvic haematoma.
Figures and Tables -
Analysis 3.12

Comparison 3 LH versus VH, Outcome 12 Pelvic haematoma.

Comparison 3 LH versus VH, Outcome 13 Unintended laparotomy.
Figures and Tables -
Analysis 3.13

Comparison 3 LH versus VH, Outcome 13 Unintended laparotomy.

Comparison 3 LH versus VH, Outcome 14 Vaginal cuff infection.
Figures and Tables -
Analysis 3.14

Comparison 3 LH versus VH, Outcome 14 Vaginal cuff infection.

Comparison 3 LH versus VH, Outcome 15 Wound/abdominal wall infection.
Figures and Tables -
Analysis 3.15

Comparison 3 LH versus VH, Outcome 15 Wound/abdominal wall infection.

Comparison 3 LH versus VH, Outcome 16 Urinary tract infection.
Figures and Tables -
Analysis 3.16

Comparison 3 LH versus VH, Outcome 16 Urinary tract infection.

Comparison 3 LH versus VH, Outcome 17 Chest infection.
Figures and Tables -
Analysis 3.17

Comparison 3 LH versus VH, Outcome 17 Chest infection.

Comparison 3 LH versus VH, Outcome 18 Febrile episodes or unspecified infection.
Figures and Tables -
Analysis 3.18

Comparison 3 LH versus VH, Outcome 18 Febrile episodes or unspecified infection.

Comparison 3 LH versus VH, Outcome 19 Thromboembolism.
Figures and Tables -
Analysis 3.19

Comparison 3 LH versus VH, Outcome 19 Thromboembolism.

Comparison 3 LH versus VH, Outcome 20 Length of hospital stay (days).
Figures and Tables -
Analysis 3.20

Comparison 3 LH versus VH, Outcome 20 Length of hospital stay (days).

Study

LH

VH

Comments

Richardson 1995

n = 22
mean = 23.1 days
range (7 to 56)

n = 23
mean = 22.2
range (7 to 56)

Roy 2011

TLH: n = 30

median = 15 days

min‐max = 7 to 30 days

LAVH: n = 30

median = 20 days

min‐max = 8 to 40 days

n = 30

median = 14 days

min‐max = 7 to 25 days

P value = 0.7

Roy 2012

n = 10

median = 20 days

min‐max = 10 to 30 days

n = 10

median = 16 days

min‐max = 12 to 24 days

P value = 0.05

Figures and Tables -
Analysis 3.21

Comparison 3 LH versus VH, Outcome 21 Return to normal activities (descriptive data).

Study

Description

LH

VH

Comment

Roy 2011

Patient satisfaction was evaluated using HRQOL (Health Related Quality Of Life) questionnaire and SF‐12 (12‐item Short Form health survey) and follow‐up visits in outpatient clinic were done at 1, 3 and 6 months

TLH: n = 30

LAVH: n = 30

n = 30

After 6 months of surgery, there was significant higher satisfaction rate among patients who underwent TLH and NDVH (non‐descent vaginal hysterectomy) than those who underwent LAVH (P value = 0.003). The satisfaction was similar between the TLH and NDVH group

Figures and Tables -
Analysis 3.22

Comparison 3 LH versus VH, Outcome 22 Long‐term outcomes: quality of life (descriptive data).

Study

LH

VH

Comments

Hwang 2002

With 2nd proc:
n = 13
Median = 119
Range (80 to 165)
Without 2nd proc:
n = 17
Median = 109
Range (85 to 175)

With 2nd proc:
n = 3
Median = 93
Range (80 to 110)
Without 2nd proc:
n = 27
Median = 74
Range (40 to 120)

Kruskal Wallis test:
P value = 0.12
P value < 0.001

Ribeiro 2003

n = 20
mean 119 mins (no measure of spread)

n = 20
mean 78 mins (no measure of spread)

Richardson 1995

n = 22
mean = 131.4 mins
range (76 to 180)

n = 23
mean = 76.7 mins
range (35 to 150)

Some of these cases include oophorectomies. Oophorectomy (mean): LH 129.7 mins, VH 95.3 mins; no oophorectomy (mean): LH 132.7 mins, VH 64.7 mins

Roy 2012

n = 10

median = 90 mins

min‐max = 60 to 165 mins

n = 10

median = 75

min‐max = 40 to 105

Not statistically significant

Figures and Tables -
Analysis 3.23

Comparison 3 LH versus VH, Outcome 23 Operation time (descriptive data).

Study

LH

VH

Comments

Hwang 2002

n = 30
median = 4.7 days
range (3 to 7)

n = 30
median = 4.7 days
range (3 to 7)

Not tested separately

Richardson 1995

n = 22
mean = 3.2 days
range (2 to 7)

n = 23
mean = 3.3 days
range (1 to 18)

Roy 2011

TLH: n = 30

median = 2 days

min‐max = 2 to 12 days

LAVH: n = 30

median = 3 days

min‐max = 4 days

VH: n = 30

median = 2 days

min‐max = 1 to 4 days

P value = 0.15

Roy 2012

n = 10

median = 3 days

min‐max = 2 to 4 days

n = 10

median = 2 days

min‐max = 2 to 4 days

Not statistically significant

Figures and Tables -
Analysis 3.24

Comparison 3 LH versus VH, Outcome 24 Length of hospital stay (descriptive data).

Study

Description

LH

VH

Conclusion

Pain scales

Ghezzi 2010

VAS pain scores at several times post surgery

n = 41

VAS score after 1 h: mean = 4.7, SD = 2.6

VAS score after 3 h: mean = 3.2, SD = 2.5

VAS score after 8 h: mean = 2.1, SD = 2.2

VAS score after 24 h:

mean = 1.8, SD = 1.7

n = 41

VAS score after 1 h:

mean = 7.8, SD = 1.7

VAS score after 3 h:

mean = 6.6, SD = 2.0

VAS score after 8 h:

mean = 5.3, SD = 2.1

VAS score after 24 h:

mean = 3.6, SD = 2.6

P value < 0.0001

P value < 0.0001

P value < 0.0001

P value = 0.001

Sesti 2008b

VAS pain 24 hours post surgery

6 patients (15%) reported absence of pain 24 hours post surgery

20 patients (50%) reported absence of pain (VAS = 0) 24 hours post surgery

Patients undergoing LAVH had more postoperative pain compared with patients undergoing VH

Postoperative analgesics

Ghezzi 2010

The need for additional use of analgesics after the operation

n = 41

7 (17.1%)

n = 41

32 (78.0%)

P value < 0.0001

Richardson 1995

The number of postoperative opoid injections and the number of days analgesia was required was recorded

n = 22
Opoid injections: mean = 2.3, range (0 to 8)
Analgesia required: mean = 2.9 days, range (0 to 20)

n = 23
Opoid injections: mean = 2.6, range (0 to 15)
Analgesia required: mean = 2.6 days, range (1 to 17)

The number of opoid injections and analgesia requirements were similar in each group

Soriano 2001

Total consumption of paracetamol, NSAID and subcutaneous opoid

n = 37
Paracetamol: mean = 11.1 g, SD = 5.6
NSAID:mean = 137 mg, SD = 148
Opoid: mean 6.8 mg, SD = 13.7

n = 40
Paracetamol: mean = 10.1 g, SD = 6.7
NSAID: mean = 137 mg, SD = 155
Opoid: mean = 8.7 mg, SD = 15.7

No significant difference in the total consumption of paracetamol, NSAID and subcutaneous opoid between the 2 groups

Summitt 1992

Pain control was assessed by documenting the intramuscular narcotic use on the day of surgery and the number of pain tablets used on the day of surgery and the first 2 postoperative days

n = 28
Number of oral pain tablets.
Day of surgery: mean = 3.13, SD = 2.1, range(0 to 9). P value = NS
Postop Day 1: mean = 3.67, SD = 2.5, range (1 to 10). P value = NS
Postop Day 2: mean = 2.71, SD = 2.9, range (0 to 12). P value = 0.27
Number of participants requiring IM narcotics within the first 6 hours after surgery: 9

n = 27
Number of oral pain tablets.
Day of surgery: mean = 3.82, SD = 1.8, range (0 to 7). P value = NS
Postop Day 1: mean = 3.61, SD = 2.3, range (0 to 10). P value = NS
Postop Day 2: mean = 1.57, SD = 1.5, range (0 to 5). P value = 0.27
Number of participants requiring IM narcotics within the first 6 hours after surgery: 8

Figures and Tables -
Analysis 3.25

Comparison 3 LH versus VH, Outcome 25 Pain relief (descriptive data).

Study

Description

LH

VH

Summitt 1992

Mean total hospital charge when surgery was performed on an outpatient basis. Charges consisted of: operating room fee, operating room time, anaesthesia time, charges for disposable staples, scissors, graspers and a charge for recovery in the ambulatory surgery unit, including laboratory fees

n = 29
Mean = USD 7905, SD = 501, range (7197 to 8289), P value = 0.035

n = 27
Mean = USD 4891, SD = 355, range (4311 to 5247),
P value = 0.035

Figures and Tables -
Analysis 3.26

Comparison 3 LH versus VH, Outcome 26 Cost (descriptive data).

Comparison 4 RH versus LH, Outcome 1 Return to normal activities (days).
Figures and Tables -
Analysis 4.1

Comparison 4 RH versus LH, Outcome 1 Return to normal activities (days).

Comparison 4 RH versus LH, Outcome 2 Intraoperative visceral injury (dichotomous).
Figures and Tables -
Analysis 4.2

Comparison 4 RH versus LH, Outcome 2 Intraoperative visceral injury (dichotomous).

Comparison 4 RH versus LH, Outcome 3 Operation time.
Figures and Tables -
Analysis 4.3

Comparison 4 RH versus LH, Outcome 3 Operation time.

Comparison 4 RH versus LH, Outcome 4 Transfusion.
Figures and Tables -
Analysis 4.4

Comparison 4 RH versus LH, Outcome 4 Transfusion.

Study

Description

RH

LH

Comment

Paraiso 2013

Percentage to return to normal baseline activities

at 1, 2, 3, 4, 5 and 6 weeks postoperatively

1 week (n = 17): 22%

2 weeks (n = 17): 46%

3 weeks (n = 17): 54%

4 weeks (n = 17): 60%

5 weeks (n = 17): 66%

6 weeks (n = 16): 72%

1 week (n = 19): 29%

2 weeks (n = 19): 46%

3 weeks (n = 18): 58%

4 weeks (n = 18): 64%

5 weeks (n = 17): 73%

6 weeks (n = 17): 82%

P value (overall) = 0.25

Figures and Tables -
Analysis 4.5

Comparison 4 RH versus LH, Outcome 5 Return to normal activities (descriptive data).

Comparison 5 SP‐LH versus LH, Outcome 1 Bladder injury.
Figures and Tables -
Analysis 5.1

Comparison 5 SP‐LH versus LH, Outcome 1 Bladder injury.

Comparison 5 SP‐LH versus LH, Outcome 2 Operation time (mins).
Figures and Tables -
Analysis 5.2

Comparison 5 SP‐LH versus LH, Outcome 2 Operation time (mins).

Comparison 5 SP‐LH versus LH, Outcome 3 Transfusion.
Figures and Tables -
Analysis 5.3

Comparison 5 SP‐LH versus LH, Outcome 3 Transfusion.

Comparison 5 SP‐LH versus LH, Outcome 4 Pelvic haematoma.
Figures and Tables -
Analysis 5.4

Comparison 5 SP‐LH versus LH, Outcome 4 Pelvic haematoma.

Comparison 5 SP‐LH versus LH, Outcome 5 Wound/abdominal wall infection.
Figures and Tables -
Analysis 5.5

Comparison 5 SP‐LH versus LH, Outcome 5 Wound/abdominal wall infection.

Comparison 5 SP‐LH versus LH, Outcome 6 Febrile episodes or unspecified infection.
Figures and Tables -
Analysis 5.6

Comparison 5 SP‐LH versus LH, Outcome 6 Febrile episodes or unspecified infection.

Comparison 5 SP‐LH versus LH, Outcome 7 Postoperative ileus.
Figures and Tables -
Analysis 5.7

Comparison 5 SP‐LH versus LH, Outcome 7 Postoperative ileus.

Comparison 5 SP‐LH versus LH, Outcome 8 Length of hospital stay (days).
Figures and Tables -
Analysis 5.8

Comparison 5 SP‐LH versus LH, Outcome 8 Length of hospital stay (days).

Study

SP‐LH

Conventional LH

Comments

Song 2013

n = 20 SP‐LAVH

Mean = 92 min

Range 57 to 220 min

n = 19 LAVH

Mean = 95 min

Range 70 to 154 min

P value = 0.47

Figures and Tables -
Analysis 5.9

Comparison 5 SP‐LH versus LH, Outcome 9 Operation time (descriptive data).

Study

SP‐LH

LAVH

Comments

Jung 2011

n = 30 SP‐TLH

Median postoperative hospital stay = 3.4 days

Range 3.0 to 4.3 days

n = 34 TLH

Median postoperative hospital stay = 3.0 days

Range 3.0 to 3.0 days

P value = 0.075

Song 2013

n = 20 SP‐LAVH

Mean = 3 days

Range 2 to 4 days

n = 19 LAVH

Mean = 3 days

Range 2 to 4 days

P value = 0.95

Figures and Tables -
Analysis 5.10

Comparison 5 SP‐LH versus LH, Outcome 10 Length of hospital stay (descriptive data).

Comparison 6 TLH versus LAVH, Outcome 1 Intraoperative visceral injury (dich).
Figures and Tables -
Analysis 6.1

Comparison 6 TLH versus LAVH, Outcome 1 Intraoperative visceral injury (dich).

Comparison 6 TLH versus LAVH, Outcome 2 Long‐term complications (dich).
Figures and Tables -
Analysis 6.2

Comparison 6 TLH versus LAVH, Outcome 2 Long‐term complications (dich).

Comparison 6 TLH versus LAVH, Outcome 3 Operation time (mins).
Figures and Tables -
Analysis 6.3

Comparison 6 TLH versus LAVH, Outcome 3 Operation time (mins).

Comparison 6 TLH versus LAVH, Outcome 4 Short‐term outcomes (dich).
Figures and Tables -
Analysis 6.4

Comparison 6 TLH versus LAVH, Outcome 4 Short‐term outcomes (dich).

Comparison 6 TLH versus LAVH, Outcome 5 Length of hospital stay (days).
Figures and Tables -
Analysis 6.5

Comparison 6 TLH versus LAVH, Outcome 5 Length of hospital stay (days).

Study

Mini‐TLH

Conventional TLH

Comments

Ghezzi 2011

n = 38

Median = 58 mins

Range: 30 to 135 mins

n = 38

Median = 60 mins

Range: 30 to 155 mins

P value = 0.55

Figures and Tables -
Analysis 7.1

Comparison 7 Mini‐LH versus TLH, Outcome 1 Operation time (descriptive data).

Study

mini‐TLH

Conventional TLH

Comment

Ghezzi 2011

n = 38

Median = 1 day

Range: 0 to 2

n = 38

Median = 1 day

Range: 1 to 2

P value = 0.73

Figures and Tables -
Analysis 7.2

Comparison 7 Mini‐LH versus TLH, Outcome 2 Length of hospital stay (descriptive data).

Summary of findings for the main comparison. Vaginal hysterectomy versus abdominal hysterectomy for benign gynaecological disease

Vaginal hysterectomy versus abdominal hysterectomy for benign gynaecological disease

Patient or population: patients with benign gynaecological disease
Settings: hospital
Intervention: vaginal versus abdominal hysterectomy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Abdominal hysterectomy

Vaginal hysterectomy

Return to normal activities (days)

The mean return to normal activities (days) in the AH group was
42.7 days

The mean return to normal activities (days) in the VH group was
9.5 lower
(12.6 to 6.4 lower)

176
(3 studies)

⊕⊕⊕⊝
moderate1

Urinary tract (bladder or ureter) injury

0 per 1000

0 per 1000
(0 to 0)

OR 3.09
(0.48 to 19.97)

439
(4 studies)

⊕⊕⊕⊝
moderate2,3

There were no urinary tract injuries in one study

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
AH: abdominal hysterectomy; CI: confidence interval; OR: odds ratio; VH: vaginal hysterectomy

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1There was a large difference in return to normal activities between the different studies; the analysis had high heterogeneity (I2 = 75%) but consistent direction of effect.
2In 2 studies there was doubt about the method used for random sequence generation.
3There were only three events altogether, all in the VH arms.

Figures and Tables -
Summary of findings for the main comparison. Vaginal hysterectomy versus abdominal hysterectomy for benign gynaecological disease
Summary of findings 2. Laparoscopic hysterectomy versus abdominal hysterectomy for benign gynaecological disease

Laparoscopic hysterectomy versus abdominal hysterectomy for benign gynaecological disease

Patient or population: patients with benign gynaecological disease
Settings: hospital
Intervention: laparoscopic versus abdominal hysterectomy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Abdominal hysterectomy

Laparoscopic hysterectomy

Return to normal activities (days)

The mean return to normal activities (days) in the AH group was
36.3 days

The mean return to normal activities (days) in the LH group was
13.6 lower
(15.4 to 11.8 lower)

520
(6 studies)

⊕⊕⊝⊝
low1,2

Urinary tract (bladder or ureter) injury

10 per 1000

24 per 1000
(12 to 46)

OR 2.44
(1.24 to 4.80)

2140
(13 studies)

⊕⊕⊝⊝
low1,3

Bowel injury

7 per 1000

1 per 1000
(0 to 11)

OR 0.21
(0.03 to 1.33)

1175
(4 studies)

⊕⊕⊕⊝
moderate3

Vascular injury

9 per 1000

16 per 1000
(5 to 51)

OR 1.76
(0.52 to 5.87)

956
(2 studies)

⊕⊕⊕⊝
moderate3

Bleeding

16 per 1000

6 per 1000
(2 to 19)

OR 0.45
(0.15 to 1.37)

1266
(5 studies)

⊕⊕⊝⊝
low3,4

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
AH: abdominal hysterectomy; CI: confidence interval; LH: laparoscopic hysterectomy; OR: odds ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1In some studies there was doubt about the method used for random sequence generation or allocation of patients. Furthermore, one study did not perform an intention‐to‐treat analysis.
2There was a large difference in return to normal activities between the different studies; the analysis had moderate heterogeneity (I2 = 48%) but consistent direction of effect.
3Wide confidence intervals crossing the line of no effect.
4In some studies there was doubt about the method used for random sequence generation or allocation of participants.

Figures and Tables -
Summary of findings 2. Laparoscopic hysterectomy versus abdominal hysterectomy for benign gynaecological disease
Summary of findings 3. Laparoscopic hysterectomy versus vaginal hysterectomy for benign gynaecological disease

Laparoscopic hysterectomy versus vaginal hysterectomy for benign gynaecological disease

Patient or population: patients with benign gynaecological disease
Settings: hospital
Intervention: laparoscopic versus vaginal hysterectomy

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Vaginal hysterectomy

Laparoscopic hysterectomy

Return to normal activities (days)

The mean return to normal activities (days) in the VH group was
25.2 days

The mean return to normal activities (days) in the LH group was
1.1 lower
(4.2 lower to 2.1 higher)

140
(2 studies)

⊕⊕⊕⊝
moderate1

Urinary tract (bladder or ureter) injury

16 per 1000

16 per 1000
(6 to 42)

OR 1.0
(0.36 to 2.75)

865
(7 studies)

⊕⊕⊝⊝
low2,3

Vascular injury

12 per 1000

18 per 1000
(6 to 58)

OR 1.58
(0.48 to 5.27)

745
(5 studies)

⊕⊕⊝⊝
low3,4

Bleeding

29 per 1000

25 per 1000
(9 to 70)

OR 2.45
(0.38 to 15.78)

644
(3 studies)

⊕⊕⊝⊝
low3,5

Unintended laparotomy

24 per 1000

37 per 1000
(19 to 73)

OR 1.55
(0.76 to 3.15)

1160
(10 studies)

⊕⊕⊝⊝
low2,3

*The basis for the assumed risk is the median control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; LH: laparoscopic hysterectomy; OR: odds ratio; VH: vaginal hysterectomy

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Wide confidence intervals crossing the line of no effect.
2In some studies there was doubt about the method used for random sequence generation or allocation of patients.
3Wide confidence intervals crossing the line of no effect.
4In one study it was unclear how participants were allocated to their study group.
5In two studies it was unclear how participants were randomised and allocated.

Figures and Tables -
Summary of findings 3. Laparoscopic hysterectomy versus vaginal hysterectomy for benign gynaecological disease
Table 1. Sub‐categorisation of laparoscopic hysterectomy

Type of LH

LH versus AH RCTs

LH versus VH RCTs

LH versus LH RCTs

LAVH

Ferrari 2000

Agostini 2006

Chen 2011

Kunz 1996

Ottosen 2000

Roy 2011

Marana 1999

Roy 2011

Song 2013

Muzii 2007

Roy 2012

Ottosen 2000

Sesti 2008(a)

Raju 1994b

Sesti 2008(b)

Sesti 2008(a)

Tsai 2003

LH(a)

Ellstrom 1998

Darai 2001

Falcone 1999

Hwang 2002

Harkki‐Siren 2000

Soriano 2001

Hwang 2002

Summitt 1992

Langebrekke 1998

Zhu 2009

Olsson 1996

Persson 2006

Schutz 2002

Seracchioli 2002

Summitt 1998

Yuen 1998

Zhu 2009

TLH

Kluivers 2007

Candiani 2009

Ghezzi 2011

Perino 1999

Ghezzi 2010

Jung 2011

Ribeiro 2003

Morelli 2007

Paraiso 2013

Ribeiro 2003

Roy 2011

Roy 2011

Sarlos 2012

Non‐categorisable LH

Garry 2004

Garry 2004

Kongwattanakul 2012

Richardson 1998

Lumsden 2000

AH: abdominal hysterectomy
LAVH: laparoscopic‐assisted vaginal hysterectomy
LH: laparoscopic hysterectomy
RCT: randomised controlled trial
TLH: total laparoscopic hysterectomy
VH: vaginal hysterectomy

Figures and Tables -
Table 1. Sub‐categorisation of laparoscopic hysterectomy
Table 2. Staging of laparoscopic hysterectomy ‐ Richardson 1995

Stage

Laparoscopic content

0

Laparoscopy done but no laparoscopic procedure before vaginal hysterectomy

1

Procedure includes laparoscopic adhesiolysis and/or excision of endometriosis

2

Either or both adnexa freed laparoscopically

3

Bladder dissected from the uterus laparoscopically

4

Uterine artery transected laparoscopically

5

Anterior and/or posterior colpotomy or entire uterus freed laparoscopically

Figures and Tables -
Table 2. Staging of laparoscopic hysterectomy ‐ Richardson 1995
Table 3. Steps of laparoscopic hysterectomy ‐ Nezhat 1995

Step

Laparoscopic content

1

Severing the round ligaments and dissection of the upper portion of the broad ligament

2

Severing the tubo‐uterine junction and the utero‐ovarian ligament if the adnexa are to be preserved, or severing the infundibulopelvic ligaments

3

Severing the uterine vessels

4

Preparation of the bladder flap

5

Severing the cardinal uterosacral ligaments complex

6

Performing anterior and posterior culdotomy and separation of the cervix

7

Closure of the vaginal cuff

Figures and Tables -
Table 3. Steps of laparoscopic hysterectomy ‐ Nezhat 1995
Table 4. Studies reporting dropouts

Trial

No. dropouts

Details

Chen 2011

2

Excluded from analysis postoperatively, because they underwent accessory adnexal surgery

Falcone 1999

4 (1 LH; 3 AH)

Withdrew pre‐operatively

Garry 2004

34 (23 LH (11 aLH; 12 vLH); 6 AH; 5 VH)

Withdrew pre‐operatively

Long 2002

13

3 laparotomy conversions were excluded from analysis; 7 incomplete records; 3 combined procedures that were excluded post‐randomisation

Lumsden 2000

10

10 dropouts were not analysed. 7 women did not attend surgery and 3 records were not available

Kluivers 2007

1

Refused assignment procedure

Lumsden 2000

10

7 withdrew pre‐operatively; 3 case records not available

Paraiso 2013

6

6 withdrew after randomisation but before the intervention was performed

Persson 2006

6

5 allocated to AH and 1 to LH withdrew after informed consent prior to the operation or withdrew in the postoperative period before the 5‐week follow‐up

Roy 2011

9

5 excluded because they needed adenectomy during surgery and 4 excluded from all analyses because they did not show up for follow‐up after intervention

Roy 2012

1

1 LH patient excluded from analysis due to conversion

Sarlos 2012

5

After randomisation 5 did not complete the study and were excluded from the analysis

Song 2013

1

1 lost to follow‐up because of dissatisfaction with hospital care

Summitt 1998

2

Refused assignment procedure

Yuen 1998

6

4 declined operation; 2 refused to participate postoperatively

AH: abdominal hysterectomy
aLH: laparoscopic cases in the abdominal arm of the eVALuate trial
LH: laparoscopic hysterectomy
VH: vaginal hysterectomy
vLH: laparoscopic cases in the vaginal arm of the eVALuate trial

Figures and Tables -
Table 4. Studies reporting dropouts
Comparison 1. VH versus AH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Return to normal activities (days) Show forest plot

3

176

Mean Difference (IV, Random, 95% CI)

‐12.33 [‐19.89, ‐4.77]

2 Long‐term outcomes: satisfaction (dichotomous) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Intraoperative visceral injury (dichotomous) Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Bladder injury

4

439

Odds Ratio (M‐H, Fixed, 95% CI)

3.09 [0.48, 19.97]

3.2 Ureter injury

1

119

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Urinary tract (bladder or ureter) injury

4

439

Odds Ratio (M‐H, Fixed, 95% CI)

3.09 [0.48, 19.97]

3.4 Bowel injury

2

319

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.5 Vascular injury

1

119

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Long‐term complications (dichotomous) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Urinary dysfunction

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Operation time (mins) Show forest plot

4

Mean Difference (IV, Random, 95% CI)

Subtotals only

5.1 VH versus standard AH

3

259

Mean Difference (IV, Random, 95% CI)

‐11.01 [‐35.09, 13.08]

5.2 VH versus minilaparotomy AH

1

100

Mean Difference (IV, Random, 95% CI)

‐63.0 [‐65.11, ‐60.89]

6 Short‐term outcomes (dichotomous) Show forest plot

6

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 Transfusion

5

495

Odds Ratio (M‐H, Fixed, 95% CI)

0.82 [0.34, 1.96]

6.2 Pelvic haematoma

5

535

Odds Ratio (M‐H, Fixed, 95% CI)

0.99 [0.34, 2.89]

6.3 Vaginal cuff infection

2

140

Odds Ratio (M‐H, Fixed, 95% CI)

3.08 [0.12, 77.80]

6.4 Wound/abdominal wall infection

3

355

Odds Ratio (M‐H, Fixed, 95% CI)

0.21 [0.04, 1.00]

6.5 UTI

3

176

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.08, 4.61]

6.6 Chest infection

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.13, 7.60]

6.7 Febrile episodes or unspecified infection

5

495

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.36, 1.08]

6.8 Thromboembolism

1

119

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Length of hospital stay (days) Show forest plot

5

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 VH versus standard AH

4

295

Mean Difference (IV, Fixed, 95% CI)

‐1.07 [‐1.22, ‐0.92]

7.2 VH versus minilaparotomy AH

1

100

Mean Difference (IV, Fixed, 95% CI)

‐2.1 [‐2.19, ‐2.01]

8 All outcomes, descriptive data Show forest plot

Other data

No numeric data

8.1 Quality of life (descriptive data)

Other data

No numeric data

8.2 Operation time (descriptive data)

Other data

No numeric data

8.3 Length of hospital stay (descriptive data)

Other data

No numeric data

Figures and Tables -
Comparison 1. VH versus AH
Comparison 2. LH versus AH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Return to normal activities (days) Show forest plot

6

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 LAVH versus AH

1

80

Mean Difference (IV, Fixed, 95% CI)

‐8.40 [‐12.15, ‐4.65]

1.2 LH(a) versus AH

5

440

Mean Difference (IV, Fixed, 95% CI)

‐15.17 [‐17.21, ‐13.14]

2 Satisfaction Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 LH (method unspecified) versus AH

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Bladder injury Show forest plot

12

2038

Odds Ratio (M‐H, Fixed, 95% CI)

1.89 [0.91, 3.90]

3.1 LAVH versus AH

3

396

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 7.17]

3.2 LH(a) versus AH

4

427

Odds Ratio (M‐H, Fixed, 95% CI)

2.02 [0.49, 8.24]

3.3 TLH versus AH

2

99

Odds Ratio (M‐H, Fixed, 95% CI)

0.58 [0.05, 6.73]

3.4 LH (method unspecified) versus AH

3

1116

Odds Ratio (M‐H, Fixed, 95% CI)

2.65 [0.88, 7.93]

4 Ureter injury Show forest plot

7

1417

Odds Ratio (M‐H, Fixed, 95% CI)

3.46 [0.94, 12.71]

4.1 LH(a) versus AH

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

6.12 [0.29, 130.87]

4.2 TLH versus AH

3

201

Odds Ratio (M‐H, Fixed, 95% CI)

3.35 [0.34, 32.97]

4.3 LH (method unspecified) versus AH

3

1116

Odds Ratio (M‐H, Fixed, 95% CI)

2.82 [0.44, 18.03]

5 Urinary tract (bladder or ureter) injury Show forest plot

13

2140

Odds Ratio (M‐H, Fixed, 95% CI)

2.44 [1.24, 4.80]

5.1 LAVH versus AH

3

396

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.14, 7.17]

5.2 LH(a) versus AH

4

427

Odds Ratio (M‐H, Fixed, 95% CI)

2.79 [0.73, 10.68]

5.3 TLH versus AH

3

201

Odds Ratio (M‐H, Fixed, 95% CI)

1.61 [0.30, 8.63]

5.4 LH (method unspecified) versus AH

3

1116

Odds Ratio (M‐H, Fixed, 95% CI)

3.13 [1.12, 8.78]

6 Bowel injury Show forest plot

4

1175

Odds Ratio (M‐H, Fixed, 95% CI)

0.21 [0.03, 1.33]

6.1 LAVH versus AH

1

50

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.25]

6.2 TLH versus AH

1

59

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.3 LH (method unspecified) versus AH

2

1066

Odds Ratio (M‐H, Fixed, 95% CI)

0.17 [0.02, 1.60]

7 Vascular injury Show forest plot

2

956

Odds Ratio (M‐H, Fixed, 95% CI)

1.76 [0.52, 5.87]

7.1 LAVH versus AH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

5.26 [0.24, 113.11]

7.2 LH (method unspecified) versus AH

1

876

Odds Ratio (M‐H, Fixed, 95% CI)

1.34 [0.35, 5.08]

8 Fistula Show forest plot

2

245

Odds Ratio (M‐H, Fixed, 95% CI)

3.07 [0.32, 29.96]

8.1 LH(a) versus AH

1

143

Odds Ratio (M‐H, Fixed, 95% CI)

3.09 [0.12, 77.01]

8.2 TLH versus AH

1

102

Odds Ratio (M‐H, Fixed, 95% CI)

3.06 [0.12, 76.88]

9 Urinary dysfunction Show forest plot

2

246

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.48, 1.84]

9.1 LAVH versus AH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

3.08 [0.12, 77.80]

9.2 LH (method unspecified) versus AH

1

166

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.44, 1.76]

10 Operation time (mins) Show forest plot

12

Mean Difference (IV, Random, 95% CI)

Subtotals only

10.1 LAVH versus AH

4

466

Mean Difference (IV, Random, 95% CI)

0.27 [‐23.39, 23.93]

10.2 LH(A) versus AH

5

420

Mean Difference (IV, Random, 95% CI)

33.45 [14.82, 52.08]

10.3 TLH versus AH

2

161

Mean Difference (IV, Random, 95% CI)

28.74 [2.64, 54.85]

10.4 LAVH versus minilaparotomy AH

1

100

Mean Difference (IV, Random, 95% CI)

‐8.0 [‐10.56, ‐5.44]

11 Bleeding Show forest plot

5

1266

Odds Ratio (M‐H, Fixed, 95% CI)

0.45 [0.15, 1.37]

11.1 LAVH versus AH

2

197

Odds Ratio (M‐H, Fixed, 95% CI)

0.60 [0.08, 4.64]

11.2 LH(a) versus AH

2

193

Odds Ratio (M‐H, Fixed, 95% CI)

0.16 [0.02, 1.34]

11.3 LH (method unspecified) versus AH

1

876

Odds Ratio (M‐H, Fixed, 95% CI)

1.50 [0.16, 14.51]

12 Transfusion Show forest plot

19

2638

Odds Ratio (M‐H, Random, 95% CI)

0.58 [0.30, 1.10]

12.1 LAVH versus AH

5

539

Odds Ratio (M‐H, Random, 95% CI)

0.38 [0.11, 1.34]

12.2 LH(a) versus AH

8

641

Odds Ratio (M‐H, Random, 95% CI)

0.47 [0.17, 1.35]

12.3 TLH versus AH

2

161

Odds Ratio (M‐H, Random, 95% CI)

0.27 [0.03, 2.47]

12.4 LH (method unspecified) versus AH

3

1116

Odds Ratio (M‐H, Random, 95% CI)

0.91 [0.08, 9.85]

12.5 LAVH versus minilaparotomy AH

2

181

Odds Ratio (M‐H, Random, 95% CI)

1.38 [0.09, 20.52]

13 Pelvic haematoma Show forest plot

8

782

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.38, 1.47]

13.1 LAVH versus AH

3

276

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.05, 2.10]

13.2 LH(a) versus AH

4

406

Odds Ratio (M‐H, Fixed, 95% CI)

0.93 [0.44, 1.97]

13.3 LAVH versus minilaparotomy AH

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

14 Unintended laparotomy Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 LAVH versus minilaparotomy AH

2

181

Odds Ratio (M‐H, Fixed, 95% CI)

0.49 [0.08, 2.82]

15 Length of hospital stay (days) Show forest plot

11

Mean Difference (IV, Random, 95% CI)

Subtotals only

15.1 LAVH versus AH

4

466

Mean Difference (IV, Random, 95% CI)

‐2.64 [‐4.16, ‐1.12]

15.2 LH(a) versus AH

4

380

Mean Difference (IV, Random, 95% CI)

‐1.82 [‐2.34, ‐1.31]

15.3 TLH versus AH

2

161

Mean Difference (IV, Random, 95% CI)

‐2.53 [‐5.08, 0.01]

15.4 LAVH versus minilaparotomy AH

1

100

Mean Difference (IV, Random, 95% CI)

‐1.1 [‐1.20, ‐1.00]

16 Vaginal cuff infection Show forest plot

9

852

Odds Ratio (M‐H, Fixed, 95% CI)

1.43 [0.67, 3.04]

16.1 LAVH versus AH

3

396

Odds Ratio (M‐H, Fixed, 95% CI)

0.75 [0.17, 3.37]

16.2 LH(a) versus AH

6

456

Odds Ratio (M‐H, Fixed, 95% CI)

1.79 [0.73, 4.37]

17 Wound/abdominal wall infection Show forest plot

6

611

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.12, 0.71]

17.1 LAVH versus AH

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.01, 4.19]

17.2 LH(a) versus AH

4

259

Odds Ratio (M‐H, Fixed, 95% CI)

0.35 [0.12, 1.03]

17.3 LH (method unspecified) versus AH

1

190

Odds Ratio (M‐H, Fixed, 95% CI)

0.24 [0.03, 2.21]

17.4 LAVH versus minilaparotomy AH

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.01, 4.19]

18 Urinary tract infection Show forest plot

8

659

Odds Ratio (M‐H, Fixed, 95% CI)

1.04 [0.54, 2.00]

18.1 LAVH versus AH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

18.2 LH(a) versus AH

5

339

Odds Ratio (M‐H, Fixed, 95% CI)

1.27 [0.55, 2.95]

18.3 LH (method unspecified) versus AH

2

240

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.26, 2.69]

19 Chest infection Show forest plot

3

294

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.07, 1.35]

19.1 LH(a) versus AH

2

104

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.10, 3.93]

19.2 LH (method not specified) versus AH

1

190

Odds Ratio (M‐H, Fixed, 95% CI)

0.11 [0.01, 2.01]

20 Febrile episodes or unspecified infection Show forest plot

16

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

20.1 LAVH versus AH

4

339

Odds Ratio (M‐H, Fixed, 95% CI)

0.25 [0.09, 0.73]

20.2 LH(a) versus AH

7

572

Odds Ratio (M‐H, Fixed, 95% CI)

0.55 [0.33, 0.90]

20.3 TLH versus AH

2

161

Odds Ratio (M‐H, Fixed, 95% CI)

0.36 [0.11, 1.21]

20.4 LH (method unspecified) versus AH

3

1116

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.65, 1.37]

20.5 LAVH versus minilaparotomy AH

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

0.14 [0.01, 2.72]

21 Thromboembolism Show forest plot

3

1125

Odds Ratio (M‐H, Fixed, 95% CI)

0.89 [0.23, 3.39]

21.1 TLH versus AH

1

59

Odds Ratio (M‐H, Fixed, 95% CI)

0.38 [0.01, 9.76]

21.2 LH (method unspecified) versus AH

2

1066

Odds Ratio (M‐H, Fixed, 95% CI)

1.11 [0.24, 5.13]

22 Wound dehiscence Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

22.1 LAVH versus minilaparotomy AH

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

3.15 [0.12, 79.69]

23 Return to normal activities (descriptive data) Show forest plot

Other data

No numeric data

24 Long‐term outcomes: quality of life (descriptive data) Show forest plot

Other data

No numeric data

25 Operation time (descriptive data) Show forest plot

Other data

No numeric data

26 Length of hospital stay (descriptive data) Show forest plot

Other data

No numeric data

27 Pain relief (descriptive data) Show forest plot

Other data

No numeric data

27.1 Pain scales

Other data

No numeric data

27.2 Postoperative analgesics

Other data

No numeric data

27.3 Recovery from pain (days)

Other data

No numeric data

28 Cost (descriptive data) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 2. LH versus AH
Comparison 3. LH versus VH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Return to normal activities (days) Show forest plot

2

140

Mean Difference (IV, Fixed, 95% CI)

‐1.07 [‐4.21, 2.06]

1.1 LAVH versus VH

1

80

Mean Difference (IV, Fixed, 95% CI)

‐1.60 [‐5.11, 1.91]

1.2 LH(a) versus VH

1

60

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐5.95, 7.95]

2 Ureter injury Show forest plot

2

594

Odds Ratio (M‐H, Fixed, 95% CI)

1.51 [0.06, 37.18]

2.1 LAVH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.3 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

1.51 [0.06, 37.18]

3 Bladder injury Show forest plot

7

895

Odds Ratio (M‐H, Fixed, 95% CI)

0.91 [0.32, 2.56]

3.1 LAVH versus VH

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

3.2 LH(a) versus VH

2

136

Odds Ratio (M‐H, Fixed, 95% CI)

2.98 [0.30, 29.43]

3.3 TLH versus VH

2

85

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.26]

3.4 LH (method unspecified) versus VH

2

549

Odds Ratio (M‐H, Fixed, 95% CI)

0.83 [0.18, 3.79]

4 Urinary tract (bladder or ureter) injury Show forest plot

7

895

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.36, 2.75]

4.1 LAVH versus VH

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.22]

4.2 LH(a) versus VH

2

136

Odds Ratio (M‐H, Fixed, 95% CI)

2.98 [0.30, 29.43]

4.3 TLH versus VH

2

85

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.26]

4.4 LH (method unspecified) versus VH

2

549

Odds Ratio (M‐H, Fixed, 95% CI)

1.01 [0.23, 4.38]

5 Bowel injury Show forest plot

2

639

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.1 LAVH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.2 TLH versus VH

1

90

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

5.3 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Vascular injury Show forest plot

4

685

Odds Ratio (M‐H, Fixed, 95% CI)

1.58 [0.48, 5.27]

6.1 LH(a) versus VH

2

136

Odds Ratio (M‐H, Fixed, 95% CI)

2.89 [0.11, 74.15]

6.2 LH (method unspecified) versus VH

2

549

Odds Ratio (M‐H, Fixed, 95% CI)

1.42 [0.39, 5.22]

7 Fistula Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 LH(a) versus VH

1

56

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.01, 7.67]

8 Urinary dysfunction Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 LAVH versus VH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

3.08 [0.12, 77.80]

9 Operation time (mins) Show forest plot

9

Mean Difference (IV, Random, 95% CI)

Subtotals only

9.1 LAVH versus VH

5

377

Mean Difference (IV, Random, 95% CI)

33.60 [20.13, 47.07]

9.2 LH(a) versus VH

3

213

Mean Difference (IV, Random, 95% CI)

53.58 [43.67, 63.49]

9.3 TLH versus VH

1

60

Mean Difference (IV, Random, 95% CI)

17.30 [3.34, 31.26]

10 Bleeding Show forest plot

3

614

Odds Ratio (M‐H, Fixed, 95% CI)

1.55 [0.24, 10.09]

10.1 LAVH versus VH

2

65

Odds Ratio (M‐H, Fixed, 95% CI)

1.58 [0.06, 41.03]

10.2 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

1.58 [0.06, 41.03]

10.3 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

1.51 [0.06, 37.18]

11 Transfusion Show forest plot

8

1039

Odds Ratio (M‐H, Fixed, 95% CI)

1.60 [0.80, 3.18]

11.1 LAVH versus VH

4

273

Odds Ratio (M‐H, Fixed, 95% CI)

0.74 [0.16, 3.41]

11.2 LH(a) versus VH

3

217

Odds Ratio (M‐H, Fixed, 95% CI)

2.49 [0.63, 9.86]

11.3 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

1.58 [0.06, 41.03]

11.4 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

1.74 [0.63, 4.79]

12 Pelvic haematoma Show forest plot

4

308

Odds Ratio (M‐H, Fixed, 95% CI)

1.21 [0.36, 4.03]

12.1 LAVH versus VH

3

228

Odds Ratio (M‐H, Fixed, 95% CI)

1.70 [0.40, 7.26]

12.2 LH(a) versus VH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

0.49 [0.04, 5.60]

13 Unintended laparotomy Show forest plot

10

1160

Odds Ratio (M‐H, Fixed, 95% CI)

1.55 [0.76, 3.16]

13.1 LAVH versus VH

5

353

Odds Ratio (M‐H, Fixed, 95% CI)

4.33 [0.46, 40.61]

13.2 LH(a) versus VH

3

213

Odds Ratio (M‐H, Fixed, 95% CI)

6.11 [1.06, 35.21]

13.3 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

1.58 [0.06, 41.03]

13.4 LH (method unspecified) versus VH

2

549

Odds Ratio (M‐H, Fixed, 95% CI)

0.67 [0.26, 1.74]

14 Vaginal cuff infection Show forest plot

4

276

Odds Ratio (M‐H, Fixed, 95% CI)

0.98 [0.22, 4.39]

14.1 LAVH versus VH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 16.56]

14.2 LH(a) versus VH

3

196

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.16, 5.73]

15 Wound/abdominal wall infection Show forest plot

2

170

Odds Ratio (M‐H, Fixed, 95% CI)

2.88 [0.31, 27.06]

15.1 LAVH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

2.72 [0.12, 60.29]

15.2 LH(a) versus VH

1

80

Odds Ratio (M‐H, Fixed, 95% CI)

3.08 [0.12, 77.80]

15.3 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Urinary tract infection Show forest plot

3

230

Odds Ratio (M‐H, Fixed, 95% CI)

1.66 [0.40, 6.82]

16.1 LAVH versus VH

2

125

Odds Ratio (M‐H, Fixed, 95% CI)

1.02 [0.15, 6.89]

16.2 LH(a) versus VH

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

3.10 [0.12, 79.23]

16.3 TLH versus VH

1

45

Odds Ratio (M‐H, Fixed, 95% CI)

2.72 [0.12, 60.29]

17 Chest infection Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

17.1 LH(a) versus VH

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.19 [0.01, 4.06]

18 Febrile episodes or unspecified infection Show forest plot

9

1074

Odds Ratio (M‐H, Fixed, 95% CI)

0.80 [0.51, 1.24]

18.1 LAVH versus VH

4

253

Odds Ratio (M‐H, Fixed, 95% CI)

1.55 [0.49, 4.85]

18.2 LH(a) versus VH

3

196

Odds Ratio (M‐H, Fixed, 95% CI)

0.99 [0.28, 3.51]

18.3 TLH versus VH

2

121

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.06, 1.74]

18.4 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.41, 1.25]

19 Thromboembolism Show forest plot

2

564

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.15, 6.67]

19.1 TLH versus VH

1

60

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.24]

19.2 LH (method unspecified) versus VH

1

504

Odds Ratio (M‐H, Fixed, 95% CI)

2.52 [0.12, 52.76]

20 Length of hospital stay (days) Show forest plot

7

525

Mean Difference (IV, Random, 95% CI)

0.88 [0.73, 1.03]

20.1 LAVH versus VH

4

308

Mean Difference (IV, Random, 95% CI)

0.91 [0.76, 1.06]

20.2 LH(a) versus VH

2

157

Mean Difference (IV, Random, 95% CI)

0.40 [‐0.42, 1.22]

20.3 TLH versus VH

1

60

Mean Difference (IV, Random, 95% CI)

‐0.5 [‐2.41, 1.41]

21 Return to normal activities (descriptive data) Show forest plot

Other data

No numeric data

22 Long‐term outcomes: quality of life (descriptive data) Show forest plot

Other data

No numeric data

23 Operation time (descriptive data) Show forest plot

Other data

No numeric data

24 Length of hospital stay (descriptive data) Show forest plot

Other data

No numeric data

25 Pain relief (descriptive data) Show forest plot

Other data

No numeric data

25.1 Pain scales

Other data

No numeric data

25.2 Postoperative analgesics

Other data

No numeric data

26 Cost (descriptive data) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 3. LH versus VH
Comparison 4. RH versus LH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Return to normal activities (days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2 Intraoperative visceral injury (dichotomous) Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Ureter injury

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

2.2 Vascular injury

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

1.0 [0.06, 16.44]

2.3 Wound/abdominal wall infection

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

2.4 Wound dehiscence

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

3 Operation time Show forest plot

2

152

Mean Difference (IV, Random, 95% CI)

44.09 [5.31, 82.88]

4 Transfusion Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5 Return to normal activities (descriptive data) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 4. RH versus LH
Comparison 5. SP‐LH versus LH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Bladder injury Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 SP‐TLH versus TLH

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

3.51 [0.14, 89.42]

2 Operation time (mins) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 SP‐LAVH versus LAVH

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2.2 SP‐TLH versus TLH

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Transfusion Show forest plot

3

203

Odds Ratio (M‐H, Fixed, 95% CI)

1.37 [0.30, 6.26]

3.1 SP‐LAVH versus LAVH

2

139

Odds Ratio (M‐H, Fixed, 95% CI)

0.97 [0.16, 5.86]

3.2 SP‐TLH versus TLH

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

3.51 [0.14, 89.42]

4 Pelvic haematoma Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 SP‐LAVH versus LAVH

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

3.06 [0.12, 76.95]

5 Wound/abdominal wall infection Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 SP‐LAVH versus LAVH

1

100

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.21]

6 Febrile episodes or unspecified infection Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 SP‐TLH versus TLH

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

4.87 [0.93, 25.62]

7 Postoperative ileus Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 SP‐TLH versus TLH

1

64

Odds Ratio (M‐H, Fixed, 95% CI)

2.36 [0.20, 27.39]

8 Length of hospital stay (days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 SP‐LAVH versus LAVH

1

100

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.49, 0.09]

9 Operation time (descriptive data) Show forest plot

Other data

No numeric data

10 Length of hospital stay (descriptive data) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 5. SP‐LH versus LH
Comparison 6. TLH versus LAVH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intraoperative visceral injury (dich) Show forest plot

2

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Bladder injury

2

161

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.06, 8.27]

1.2 Ureter injury

2

161

Odds Ratio (M‐H, Fixed, 95% CI)

3.03 [0.27, 34.52]

1.3 Urinary tract (bladder or ureter) injury

2

161

Odds Ratio (M‐H, Fixed, 95% CI)

1.5 [0.29, 7.83]

1.4 Bowel injury

2

161

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.5 Vascular injury

1

101

Odds Ratio (M‐H, Fixed, 95% CI)

1.48 [0.09, 24.27]

1.6 Conversion to laparotomy

2

164

Odds Ratio (M‐H, Fixed, 95% CI)

1.28 [0.21, 7.85]

2 Long‐term complications (dich) Show forest plot

1

202

Odds Ratio (M‐H, Fixed, 95% CI)

1.09 [0.54, 2.17]

2.1 Dyspareunia

1

101

Odds Ratio (M‐H, Fixed, 95% CI)

2.64 [0.59, 11.72]

2.2 Orgasm (< 1 of 3)

1

101

Odds Ratio (M‐H, Fixed, 95% CI)

0.84 [0.38, 1.86]

3 Operation time (mins) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4 Short‐term outcomes (dich) Show forest plot

2

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 Transfusion

2

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Vaginal cuff infection

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Abdominal wall/wound infection

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.4 UTI

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.5 Febrile episodes or unspecified infection

2

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 Length of hospital stay (days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 6. TLH versus LAVH
Comparison 7. Mini‐LH versus TLH

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Operation time (descriptive data) Show forest plot

Other data

No numeric data

2 Length of hospital stay (descriptive data) Show forest plot

Other data

No numeric data

Figures and Tables -
Comparison 7. Mini‐LH versus TLH