Abstract
The objective of this meta-analysis was to assess whether laparoscopic-assisted vaginal
hysterectomy achieves better clinical results compared with abdominal hysterectomy.
Medline (PubMed), EMBASE, Web of Science, ProQuest, Cochrane Library and China Biological
Medicine Database were searched to identify randomized controlled trials that compared
laparoscopic-assisted vaginal hysterectomy with abdominal hysterectomy. Twenty-three
trials were studied and the analysis was performed using Review Manager Version 5
and R Version 2.11.1. The results showed that laparoscopic-assisted vaginal hysterectomy
was associated with a longer operation time, less blood loss, shorter hospital stay,
smaller haemoglobin drop, less postoperative pain, quicker return to normal activities
and fewer peri-operative complications. Quality of life is likely to be the key outcome
to evaluate the approach for hysterectomy, but further research is needed. For suitable
patients and surgeons, laparoscopic-assisted vaginal hysterectomy is a better choice
than abdominal hysterectomy.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hysterectomy in the United States 1988–1990.Obstet Gynecol. 1994; 83: 555-594
- Hysterectomy for benign disease.Obstet Gynecol. 2008; 111: 753-767
- Laparoscopic hysterectomy.J Gynecol Surg. 1989; 5: 213-216
- Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials.BMJ. 2005; 330: 1478
- Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy.BMJ. 2004; 328: 134-137
- Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review.Eur J Obstet Gynecol Reprod Biol. 2008; 136: 3-8
- Surgical approach to hysterectomy for benign gynaecological disease.Cochrane Database Syst Rev. 2009; 3: CD003677
- Comparison among minor invasive surgical approaches to hysterectomy for benign gynecological diseases: a systematic review and meta-analysis.Chin J Evid Based Med. 2009; 10: 323-338
- Total abdominal hysterectomy versus total laparoscopic hysterectomy for benign disease: a meta-analysis.Eur J Obstet Gynecol Reprod Biol. 2009; 144: 1-2
- Laparoscopic hysterectomy in current gynecological practice.Rev Gynaecol Pract. 2003; 3: 32-40
- Laparoscopic surgery is not inherently dangerous for patients presenting with benign gynaecologic pathology.Hum Reprod. 2000; 17: 1334-1342
- Cochrane handbook for systematic reviews of interventions. Version 5.0.2.The Cochrane Collaboration, 2009
- R: a language and environment for statistical computing.R Foundation for Statistical Computing, Vienna2010 (Available at:)
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339: b2700
- A handbook of statistical analyses using R.CRC Press, 2006
- Advanced methods in meta-analysis: multivariate approach and meta-regression.Stat Med. 2002; 21: 589-624
- A random-effects regression model for meta-analysis.Stat Med. 1995; 14: 395-411
- Statistical aspects of the analysis of data from retrospective studies of disease.J Natl Cancer Inst. 1959; 22: 719-748
- Beta blockade during and after myocardial infarction: an overview of the randomized trials.Prog Cardiovasc Dis. 1985; 27: 335-371
- Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634
- Comparison between laparoscopic assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy.Geburtsh Frauenheilk. 1996; 56: 453-457
- Abdominal hysterectomy should not be considered as a primary method for uterine removal. A prospective randomised study of 100 patients referred to hysterectomy.Acta Obstet Gynecol Scand. 1996; 75: 404-407
- A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates.Obstet Gynecol. 1998; 92: 321-326
- Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy.Am J Obstet Gynecol. 1999; 180: 955-962
- Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study.Am J Obstet Gynecol. 1999; 180: 270-275
- Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids.BJOG. 2000; 107: 620-625
- A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy.BJOG. 2000; 107: 1386-1391
- Three methods for hysterectomy: a randomised, prospective study of short term outcome.BJOG. 2000; 107: 1380-1385
- Clinical study of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy.Clin Med J China. 2001; 8: 483-484
- Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6 cm in diameter or uterus weighing at least 450 g: a prospective randomized study.Acta Obstet Gynecol Scand. 2002; 81: 1132-1138
- Prospective randomized comparison of laparoscopic-assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200 g.Surg Endosc. 2002; 16: 121-125
- Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section.Gynecol Obstet Invest. 2003; 55: 105-109
- Tissue trauma in abdominal and laparoscopic-assisted vaginal hysterectomy.J Am Assoc Gynecol Laparosc. 2004; 11: 467-472
- A prospective randomized study of laparoscopic assisted vaginal hysterectomy versus abdominal hysterectomy.ShangHai Med J. 2004; 27: 736-738
- Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study.J Minim Invasive Gynecol. 2007; 14: 610-615
- A comparison of vaginal, laparoscopic-assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri.Int J Gynecol Obstet. 2008; 103: 227-231
- Effects of laparoscopically-assisted vaginal hysterectomy compared with abdominal hysterectomy on immune function.J Int Med Res. 2009; 37: 855-861
- Clinical assessment for three routes of hysterectomy.Chin Med J (Engl). 2009; 122: 377-380
- A randomised prospective trial comparing laparoscopic and abdominal hysterectomy.BJOG. 1996; 103: 345-350
- Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study.Acta Obstet Gynecol Scand. 2000; 79: 866-871
- Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy.Am J Obstet Gynecol. 1998; 179: 1-5
- Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus.J Am Assoc Gynecol Laparosc. 2002; 9: 333-338
- Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study.Acta Obstet Gynecol Scand. 1998; 77: 923-928
- Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.Am J Obstet Gynecol. 1982; 144: 841-848
- Costs and charges associated with three alternative techniques of hysterectomy.N Engl J Med. 1996; 335: 476-482
- A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease.Eur J Obstet Gynecol Reprod Biol. 2010; 148: 172-176
- Twenty-first century laparoscopic hysterectomy: should we not leave the vaginal step out?.Gynecol Surg. 2009; 6: 311-316
- A multicenter review of 839 laparoscopic-assisted vaginal hysterectomies.J Am Assoc Gynecol Laparosc. 1994; 1: 417-422
- Short- and long-term clinical results of laparoscopic-assisted vaginal hysterectomy and total abdominal hysterectomy.J Am Assoc Gynecol Laparosc. 2003; 10: 49-54
- How to interpret the findings of the eVALuate study.BJOG. 2005; 112: 391-393
Article info
Publication history
Published online: May 30, 2011
Accepted:
March 28,
2011
Received in revised form:
February 12,
2011
Received:
July 20,
2010
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
