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Meta-Analysis
. 2015 Aug 12;2015(8):CD003677.
doi: 10.1002/14651858.CD003677.pub5.

Surgical approach to hysterectomy for benign gynaecological disease

Johanna W M Aarts  1 , Theodoor E Nieboer, Neil Johnson, Emma Tavender, Ray Garry, Ben Willem J Mol, Kirsten B Kluivers
Affiliations
Meta-Analysis

Surgical approach to hysterectomy for benign gynaecological disease

Johanna W M Aarts et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: The four approaches to hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and robotic-assisted hysterectomy (RH).

Objectives: To assess the effectiveness and safety of different surgical approaches to hysterectomy for women with benign gynaecological conditions.

Search methods: We searched the following databases (from inception to 14 August 2014) using the Ovid platform: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO. We also searched relevant citation lists. We used both indexed and free-text terms.

Selection criteria: We included randomised controlled trials (RCTs) in which clinical outcomes were compared between one surgical approach to hysterectomy and another.

Data collection and analysis: At least two review authors independently selected trials, assessed risk of bias and performed data extraction. Our primary outcomes were return to normal activities, satisfaction, quality of life, intraoperative visceral injury and major long-term complications (i.e. fistula, pelvi-abdominal pain, urinary dysfunction, bowel dysfunction, pelvic floor condition and sexual dysfunction).

Main results: We included 47 studies with 5102 women. The evidence for most comparisons was of low or moderate quality. The main limitations were poor reporting and imprecision. Vaginal hysterectomy (VH) versus abdominal hysterectomy (AH) (nine RCTs, 762 women)Return to normal activities was shorter in the VH group (mean difference (MD) -9.5 days, 95% confidence interval (CI) -12.6 to -6.4, three RCTs, 176 women, I(2) = 75%, moderate quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. Laparoscopic hysterectomy (LH) versus AH (25 RCTs, 2983 women)Return to normal activities was shorter in the LH group (MD -13.6 days, 95% CI -15.4 to -11.8; six RCTs, 520 women, I(2) = 71%, low quality evidence), but there were more urinary tract injuries in the LH group (odds ratio (OR) 2.4, 95% CI 1.2 to 4.8, 13 RCTs, 2140 women, I(2) = 0%, low quality evidence). There was no evidence of a difference between the groups for the other primary outcomes. LH versus VH (16 RCTs, 1440 women)There was no evidence of a difference between the groups for any primary outcomes. Robotic-assisted hysterectomy (RH) versus LH (two RCTs, 152 women)There was no evidence of a difference between the groups for any primary outcomes. Neither of the studies reported satisfaction rates or quality of life.Overall, the number of adverse events was low in the included studies.

Authors' conclusions: Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.

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Conflict of interest statement

Ray Garry is the principal investigator in a UK‐based multicentre randomised trial comparing laparoscopic with both abdominal and vaginal hysterectomy (Garry 2004).

Neil Johnson is involved in fertility and endometriosis research with the University of Auckland, has a public hospital appointment at Auckland District Health Board, and has private appointments with private medical practice groups called Endometriosis Auckland and IVF Auckland (with whom he is a shareholder); Neil Johnson has accepted funding towards conference expenses and research meetings from the following industry sponsors within the last five years, none of these sums being greater than USD 5000: Organon, Serono, Schering and Device Technologies.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each methodological quality item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
4
4
Forest plot of comparison: 1 VH versus AH, outcome: 1.1 Return to normal activities (days).
5
5
Forest plot of comparison: 2 LH versus AH, outcome: 2.1 Return to normal activities (days).
6
6
Forest plot of comparison: 3 LH versus VH, outcome: 3.1 Return to normal activities (days).
7
7
Forest plot of comparison: 4 RH versus LH, outcome: 4.1 Return to normal activities (days).
1.1
1.1. Analysis
Comparison 1 VH versus AH, Outcome 1 Return to normal activities (days).
1.2
1.2. Analysis
Comparison 1 VH versus AH, Outcome 2 Long‐term outcomes: satisfaction (dichotomous).
1.3
1.3. Analysis
Comparison 1 VH versus AH, Outcome 3 Intraoperative visceral injury (dichotomous).
1.4
1.4. Analysis
Comparison 1 VH versus AH, Outcome 4 Long‐term complications (dichotomous).
1.5
1.5. Analysis
Comparison 1 VH versus AH, Outcome 5 Operation time (mins).
1.6
1.6. Analysis
Comparison 1 VH versus AH, Outcome 6 Short‐term outcomes (dichotomous).
1.7
1.7. Analysis
Comparison 1 VH versus AH, Outcome 7 Length of hospital stay (days).
2.1
2.1. Analysis
Comparison 2 LH versus AH, Outcome 1 Return to normal activities (days).
2.2
2.2. Analysis
Comparison 2 LH versus AH, Outcome 2 Satisfaction.
2.3
2.3. Analysis
Comparison 2 LH versus AH, Outcome 3 Bladder injury.
2.4
2.4. Analysis
Comparison 2 LH versus AH, Outcome 4 Ureter injury.
2.5
2.5. Analysis
Comparison 2 LH versus AH, Outcome 5 Urinary tract (bladder or ureter) injury.
2.6
2.6. Analysis
Comparison 2 LH versus AH, Outcome 6 Bowel injury.
2.7
2.7. Analysis
Comparison 2 LH versus AH, Outcome 7 Vascular injury.
2.8
2.8. Analysis
Comparison 2 LH versus AH, Outcome 8 Fistula.
2.9
2.9. Analysis
Comparison 2 LH versus AH, Outcome 9 Urinary dysfunction.
2.10
2.10. Analysis
Comparison 2 LH versus AH, Outcome 10 Operation time (mins).
2.11
2.11. Analysis
Comparison 2 LH versus AH, Outcome 11 Bleeding.
2.12
2.12. Analysis
Comparison 2 LH versus AH, Outcome 12 Transfusion.
2.13
2.13. Analysis
Comparison 2 LH versus AH, Outcome 13 Pelvic haematoma.
2.14
2.14. Analysis
Comparison 2 LH versus AH, Outcome 14 Unintended laparotomy.
2.15
2.15. Analysis
Comparison 2 LH versus AH, Outcome 15 Length of hospital stay (days).
2.16
2.16. Analysis
Comparison 2 LH versus AH, Outcome 16 Vaginal cuff infection.
2.17
2.17. Analysis
Comparison 2 LH versus AH, Outcome 17 Wound/abdominal wall infection.
2.18
2.18. Analysis
Comparison 2 LH versus AH, Outcome 18 Urinary tract infection.
2.19
2.19. Analysis
Comparison 2 LH versus AH, Outcome 19 Chest infection.
2.20
2.20. Analysis
Comparison 2 LH versus AH, Outcome 20 Febrile episodes or unspecified infection.
2.21
2.21. Analysis
Comparison 2 LH versus AH, Outcome 21 Thromboembolism.
2.22
2.22. Analysis
Comparison 2 LH versus AH, Outcome 22 Wound dehiscence.
3.1
3.1. Analysis
Comparison 3 LH versus VH, Outcome 1 Return to normal activities (days).
3.2
3.2. Analysis
Comparison 3 LH versus VH, Outcome 2 Ureter injury.
3.3
3.3. Analysis
Comparison 3 LH versus VH, Outcome 3 Bladder injury.
3.4
3.4. Analysis
Comparison 3 LH versus VH, Outcome 4 Urinary tract (bladder or ureter) injury.
3.5
3.5. Analysis
Comparison 3 LH versus VH, Outcome 5 Bowel injury.
3.6
3.6. Analysis
Comparison 3 LH versus VH, Outcome 6 Vascular injury.
3.7
3.7. Analysis
Comparison 3 LH versus VH, Outcome 7 Fistula.
3.8
3.8. Analysis
Comparison 3 LH versus VH, Outcome 8 Urinary dysfunction.
3.9
3.9. Analysis
Comparison 3 LH versus VH, Outcome 9 Operation time (mins).
3.10
3.10. Analysis
Comparison 3 LH versus VH, Outcome 10 Bleeding.
3.11
3.11. Analysis
Comparison 3 LH versus VH, Outcome 11 Transfusion.
3.12
3.12. Analysis
Comparison 3 LH versus VH, Outcome 12 Pelvic haematoma.
3.13
3.13. Analysis
Comparison 3 LH versus VH, Outcome 13 Unintended laparotomy.
3.14
3.14. Analysis
Comparison 3 LH versus VH, Outcome 14 Vaginal cuff infection.
3.15
3.15. Analysis
Comparison 3 LH versus VH, Outcome 15 Wound/abdominal wall infection.
3.16
3.16. Analysis
Comparison 3 LH versus VH, Outcome 16 Urinary tract infection.
3.17
3.17. Analysis
Comparison 3 LH versus VH, Outcome 17 Chest infection.
3.18
3.18. Analysis
Comparison 3 LH versus VH, Outcome 18 Febrile episodes or unspecified infection.
3.19
3.19. Analysis
Comparison 3 LH versus VH, Outcome 19 Thromboembolism.
3.20
3.20. Analysis
Comparison 3 LH versus VH, Outcome 20 Length of hospital stay (days).
4.1
4.1. Analysis
Comparison 4 RH versus LH, Outcome 1 Return to normal activities (days).
4.2
4.2. Analysis
Comparison 4 RH versus LH, Outcome 2 Intraoperative visceral injury (dichotomous).
4.3
4.3. Analysis
Comparison 4 RH versus LH, Outcome 3 Operation time.
4.4
4.4. Analysis
Comparison 4 RH versus LH, Outcome 4 Transfusion.
5.1
5.1. Analysis
Comparison 5 SP‐LH versus LH, Outcome 1 Bladder injury.
5.2
5.2. Analysis
Comparison 5 SP‐LH versus LH, Outcome 2 Operation time (mins).
5.3
5.3. Analysis
Comparison 5 SP‐LH versus LH, Outcome 3 Transfusion.
5.4
5.4. Analysis
Comparison 5 SP‐LH versus LH, Outcome 4 Pelvic haematoma.
5.5
5.5. Analysis
Comparison 5 SP‐LH versus LH, Outcome 5 Wound/abdominal wall infection.
5.6
5.6. Analysis
Comparison 5 SP‐LH versus LH, Outcome 6 Febrile episodes or unspecified infection.
5.7
5.7. Analysis
Comparison 5 SP‐LH versus LH, Outcome 7 Postoperative ileus.
5.8
5.8. Analysis
Comparison 5 SP‐LH versus LH, Outcome 8 Length of hospital stay (days).
6.1
6.1. Analysis
Comparison 6 TLH versus LAVH, Outcome 1 Intraoperative visceral injury (dich).
6.2
6.2. Analysis
Comparison 6 TLH versus LAVH, Outcome 2 Long‐term complications (dich).
6.3
6.3. Analysis
Comparison 6 TLH versus LAVH, Outcome 3 Operation time (mins).
6.4
6.4. Analysis
Comparison 6 TLH versus LAVH, Outcome 4 Short‐term outcomes (dich).
6.5
6.5. Analysis
Comparison 6 TLH versus LAVH, Outcome 5 Length of hospital stay (days).
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References

References to studies included in this review

Agostini 2006 {published data only}
    1. Agostini A, Vejux N, Bretelle F, Collette E, Lapparent T, Cravello L, et al. Value of laparoscopic assistance for vaginal hysterectomy with prophylactic bilateral oophorectomy. American Journal of Obstetrics and Gynecology 2006;194(2):351‐4. - PubMed
Benassi 2002 {published data only}
    1. Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. American Journal of Obstetrics and Gynecology 2002;187:1561‐5. - PubMed
Candiani 2009 {published data only}
    1. Candiani M, Izzo S, Bulfoni A, Riparini J, Ronzoni S, Marconi A. Laparoscopic vs vaginal hysterectomy for benign pathology. American Journal of Obstetrics & Gynecology 2009;200(4):368.e1‐7. - PubMed
Chakraborty 2011 {published data only}
    1. Chakraborty S, Goswami S, Mukherjee P, Sau M. Hysterectomy..... Which route?. Journal of Obstetrics and Gynecology of India 2011;61(5):554‐7. - PMC - PubMed
Chen 2011 {published data only}
    1. Chen YJ, Wang PH, Ocampo EJ, Twu NF, Yen MS, Chao KC. Single‐port compared with conventional laparoscopic‐assisted vaginal hysterectomy. Obstetrics & Gynecology 2011;117(4):906‐12. - PubMed
Darai 2001 {published data only}
    1. Darai E, Kimtata P, Place C, Lecuru F. Vaginal hysterectomy versus laparoscopically assisted hysterectomy for enlarged uterus: a prospective randomized study. Gynaecological Endoscopy Supplement: 9th Congress of the European Society for Gynaecological Endoscopy. Paris, 2000:5.
    1. Darai E, Soriano D, Kimata P, Laplace C, Lecuru F. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstetrics and Gynecology 2001;97(5):712‐6. - PubMed
Ellstrom 1998 {published data only}
    1. Ellstrøm M, Olsen MF, Olsson J‐H, Nordberg G, Bengtsson A, Hahlin M. Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study. Acta Obstetricia et Gynecologica Scandinavica 1998;77:923‐8. - PubMed
Falcone 1999 {published data only}
    1. Falcone T, Paraiso MFR, Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. American Journal of Obstetrics & Gynecology 1999;180:955‐62. - PubMed
Ferrari 2000 {published data only}
    1. Ferrari MM, Berlanda N, Mezzopane R, Ragusa G, Cavallo M, Pardi G. Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids. British Journal of Obstetrics and Gynaecology 2000;107:620‐5. - PubMed
Garry 2004 {published data only}
    1. Garry R, Fountain J, Mason S, Napp V, Brown J, Hawe J, et al. The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ 2004;328(7432):129‐33. - PMC - PubMed
    1. Sculpher M, Manca A, Abbott J, Fountain J, Mason S, Garry R. Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial. BMJ 2004;328(7432):134. - PMC - PubMed
Ghezzi 2010 {published data only}
    1. Ghezzi F, Uccella S, Cromi A, Siesto G, Serati M, Bogani G, et al. Postoperative pain after laparoscopic and vaginal hysterectomy for benign gynecologic disease: a randomized trial. American Journal of Obstetrics and Gynecology 2010;203(2):e1‐8. - PubMed
Ghezzi 2011 {published data only}
    1. Ghezzi F, Cromi A, Siesto G, Uccella S, Boni L, Serati M, et al. Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial. Journal of Minimally Invasive Gynecology 2011;18(4):455‐61. - PubMed
Harkki‐Siren 2000 {published data only}
    1. Härkki‐Sirén P, Sjöberg J, Toivonen J, Tiitinen A. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstetricia et Gynecologica Scandinavica 2000;79:866‐71. - PubMed
Hwang 2002 {published data only}
    1. Hwang J‐L, Seow K‐M, Tsai Y‐L, Huang L‐W, Hsieh B‐C, Lee C. Comparative study of vaginal, laparoscopically assisted vaginal and abdominal hysterectomies for uterine myoma larger than 6cm in diameter or uterus weighing at least 450g: a prospective randomized study. Acta Obstetricia et Gynecologica Scandinavica 2002;81:1132‐8. - PubMed
Jung 2011 {published data only}
    1. Jung YW, Lee M, Yim GW, Lee SH, Paek JH, Kwon HY, et al. A randomized prospective study of single‐port and four‐port approaches for hysterectomy in terms of postoperative pain. Surgical Endoscopy 2011;25(8):2462‐9. [DOI: 10.1007/s00464-010-1567-z] - DOI - PubMed
Kluivers 2007 {published data only}
    1. Kluivers KB, Hendriks JCM, Mol BWJ, Bongers MY, Bremer GL, Vet HCW, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. Journal of Minimally Invasive Gynecology 2007;14(2):145‐52. - PubMed
    1. Nieboer TE, Hendriks JC, Bongers MY, Vierhout ME, Kluivers KB. Quality of life after laparoscopic and abdominal hysterectomy: a randomized controlled trial. Obstetrics & Gynecology 2012;119(1):85‐91. - PubMed
Kongwattanakul 2012 {published data only}
    1. Kongwattanakul K, Khampitak K. Comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy: a randomized controlled trial. Journal of Minimally Invasive Gynecology 2012;19(1):89‐94. - PubMed
Kunz 1996 {published data only}
    1. Kunz G, Plath T, Leyendecker G. Comparison between laparoscopic assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy. Geburtshilfe und Frauenheilkunde 1996;56:453‐7. - PubMed
Langebrekke 1996 {published data only}
    1. Langebrekke A, Eraker R, Nesheim BI, Urnes A, Busund B, Sponland G. Abdominal hysterectomy should not be considered as a primary method for uterine removal ‐ a prospective randomised study of 100 patients referred to hysterectomy. Acta Obstetrica et Gyanecologica Scandinavica 1996;75:404‐7. - PubMed
Long 2002 {published data only}
    1. Long CY, Fang JH, Chen WC, Su JH, Hsu SC. Comparison of total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy. Gynecologic and Obstetric Investigation 2002;53:214‐9. - PubMed
Lumsden 2000 {published data only}
    1. Lumsden MA, Twaddle S, Hawthorn R, Traynor I, Gilmore D, Davis J, et al. A randomised comparison and economic evaluation of laparoscopic‐assisted hysterectomy and abdominal hysterectomy. British Journal Obstetrics and Gynecology 2000;107:1386‐91. - PubMed
Marana 1999 {published data only}
    1. Marana R, Busacca M, Zupi E, Garcea N, Paparella P, Catalano GF. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. American Journal of Obstetrics and Gynecology 1999;180:270‐5. - PubMed
Miskry 2003 {published data only}
    1. Miskry T. Randomised, prospective, double‐blind comparison of abdominal versus vaginal hysterectomy. XVI FIGO World Congress Abstract Book 3. Washington DC, 2000:44.
    1. Miskry T, Magos A. Randomized, prospective, double‐blind comparison of abdominal and vaginal hysterectomy in women without uterovaginal prolapse. Acta Obstetricia et Gynaecologica Scandinavica 2003;82:351‐8. - PubMed
Muzii 2007 {published data only}
    1. Muzii L, Basile S, Zupi E, Marconi D, Zullo MA, Manci N, et al. Laparoscopic‐assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study. Journal of Minimally Invasive Gynecology 2007;14(5):610‐5. - PubMed
Olsson 1996 {published data only}
    1. Olsson J‐H, Ellstrøm M, Hahlin M. A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. British Journal of Obstetrics and Gynaecology 1996;103:345‐50. - PubMed
Ottosen 2000 {published data only}
    1. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. British Journal of Obstetrics and Gynaecology 2000;107:1380‐5. - PubMed
Paraiso 2013 {published data only}
    1. Paraiso MFR, Ridgeway B, Park AJ, Jelovsek JE, Barber MD, Falcone T, et al. A randomized trial comparing conventional and robotically assisted total laparoscopic hysterectomy. American Journal of Obstetrics & Gynecology 2013;208:e1‐7. - PubMed
Perino 1999 {published data only}
    1. Perino A, Cucinella G, Venezia R, Castelli A, Cittadini E. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Human Reproduction 1999;14:2996‐9. - PubMed
Persson 2006 {published data only}
    1. Persson P, Kjolhede P. Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology 2008;140:108‐13. - PubMed
    1. Persson P, Wijma K, Hammar M, Kjolhede P. Psychological well being after laparoscopic and abdominal hysterectomy ‐ a randomised controlled multicentre study. British Journal of Obstetrics and Gynecology 2006;113:1023‐30. - PubMed
Raju 1994 {published data only}
    1. Raju KS, Auld BJ. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo‐oophorectomy. British Journal of Obstetrics & Gynaecology 1994;101:1068‐71. - PubMed
Ribeiro 2003 {published data only}
    1. Ribeiro SC, Ribeiro RM, Santos NC, Pinotti JA. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. International Journal of Gynecology and Obstetrics 2003;83:37‐43. - PubMed
Richardson 1995 {published data only}
    1. Richardson RE, Bournas N, Magos AL. Is laparoscopic hysterectomy a waste of time?. Lancet 1995;345:36‐41. - PubMed
Roy 2011 {published data only}
    1. Roy KK, Goyal M, Singla S, Sharma JB, Malhotra N, Kumar S. A prospective randomised study of total laparoscopic hysterectomy, laparoscopically assisted vaginal hysterectomy and non‐descent vaginal hysterectomy for the treatment of benign diseases of the uterus. Archives of Gynecology and Obstetrics 2011;284(4):907‐12. - PubMed
Roy 2012 {published data only}
    1. Roy KK, Subbaiah M, Singla S, Kumar S, Sharma JB, Mitra DK. Role of serum interleukin‐6 in comparing surgical stress after laparoscopic‐assisted vaginal hysterectomy and non‐descent vaginal hysterectomy for large uteri. Archives of Gynecology and Obstetrics 2012;285(3):671‐6. - PubMed
Sarlos 2012 {published data only}
    1. Sarlos D, Kots L, Stevanovic N, Felten S, Schär G. Robotic compared with conventional laparoscopic hysterectomy: a randomized controlled trial. Obstetrics & Gynecology 2012;120(3):604‐11. - PubMed
Schutz 2002 {published data only}
    1. Schutz K, Possover M, Merker A, Michels A, Schneider A. Prospective randomized comparison of laparoscopic‐assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200g. Surgical Endoscopy 2002;16:121‐5. - PubMed
Seracchioli 2002 {published data only}
    1. Seracchioli R, Venturoli S, Vianello F, Govoni F, Cantarelli M, Gualerzi B, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. Journal of the American Association of Gynecologic Laparoscopists 2002;9(3):333‐8. - PubMed
Sesti 2008a {published data only}
    1. Sesti F, Calonzi F, Ruggeri V, Pietropoli A, Piccione E. A comparison of vaginal, laparoscopic‐assisted vaginal, and minilaparotomy hysterectomies for enlarged myomatous uteri. International Journal of Gynecology and Obstetrics 2008;103:227‐31. - PubMed
Sesti 2008b {published data only}
    1. Sesti F, Ruggeri V, Pietropolli A, Piccione E. Laparoscopically assisted vaginal hysterectomy versus vaginal hysterectomy for enlarged uterus. Journal of the Society of Laparoendoscopic Surgeons 2008;12:246‐51. - PMC - PubMed
Silva Filho 2006 {published data only}
    1. Silva‐Filho AL, Werneck RA, Magalhaes RS, Belo AV, Triginelli SA. Abdominal vs vaginal hysterectomy: a comparative study of postoperative quality of life and satisfaction. Archives of Gynecology and Obstetrics 2006;274(1):21‐4. - PubMed
Song 2013 {published data only}
    1. Song T, Cho J, Kim TJ, Kim IR, Hahm TS, Kim BG, et al. Cosmetic outcomes of laparoendoscopic single‐site hysterectomy compared with multi‐port surgery: randomized controlled trial. Journal of Minimally Invasive Gynecology 2013;20(4):460‐7. [DOI: 10.1016/j.jmig.2013.01.010] - DOI - PubMed
Soriano 2001 {published data only}
    1. Soriano D, Goldstein A, Lecuru F, Darai E. Recovery from vaginal hysterectomy compared with laparoscopy‐assisted hysterectomy: a prospective, randomized, multicenter study. Acta Obstetrica et Gynaecologica Scandinavica 2001;80:337‐41. - PubMed
Summitt 1992 {published data only}
    1. Summitt RLJr, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopy‐assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstetrics and Gynecology 1992;80:895‐901. - PubMed
Summitt 1998 {published data only}
    1. Summitt RLJr, Stovall TG, Steege JF, Lipscomb GH. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates. Obstetrics and Gynecology 1998;92:321‐6. - PubMed
Tsai 2003 {published data only}
    1. Tsai EM, Chen HS, Long CY, Yang CH, Hsu SC, Wu CH, et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light‐endorsed transvaginal section. Gynecologic and Obstetric Investigation 2003;55:105‐9. - PubMed
Yuen 1998 {published data only}
    1. Yuen PM, Mak TWL, Yim SF, Ngan Kee WD, Lam CWK, Rogers MS, et al. Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. American Journal of Obstetrics and Gynecology 1998;179:1‐5. - PubMed
Zhu 2009 {published data only}
    1. Zhu L, Lang JH, Liu CY, Shi HH, Sun ZJ, Fan R. Clinical assessment for three routes of hysterectomy. Chinese Medical Journal 2009;122(4):377‐80. - PubMed

References to studies excluded from this review

Aka 2004 {published data only}
    1. Aka N, Köse G, Gönenc I, Api M. Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: a randomised controlled study. Australian and New Zealand Journal of Obstetrics and Gynaecology 2004;44:328‐31. - PubMed
Apoola 1998 {published data only}
    1. Apoola A, Hefni MA. Hysterectomy for moderately enlarged uterus: abdominal versus vaginal hysterectomy. Journal of Obstetrics and Gynaecology 1998;18:375‐6. - PubMed
Atabekoglu 2004 {published data only}
    1. Atabekoglu C, Sönmezer M, Güngör M, Aytaç R, Ortaç F, Unlü C. Tissue trauma in abdominal and laparoscopic‐assisted vaginal hysterectomy. Journal of the American Association Gynaecological Laparoscopists 2004;11(1):467‐72. - PubMed
Cardone 2010 {published data only}
    1. Cardone A, Zarcone R, Giardiello M. Comparison of 100 of hysterectomy laparoscopic against 100 cases hysterectomy laparotomy. Minerva Ginecologica 2010;62(3):171‐7. - PubMed
Celik 2008 {published data only}
    1. Celik H, Gurates B, Yavuz A, Nurkalem C, Hanay F, Kavak B. The effect of hysterectomy and bilaterally salpingo‐oophorectomy on sexual function in post‐menopausal women. Maturitas 2008;61:358‐63. - PubMed
Chapron 1999 {published data only}
    1. Chapron C, Laforest L, Ansquer Y, Fauconnier A, Fernandez B, Breart G, et al. Hysterectomy techniques used for benign pathologies: results of a French multicentre study. Human Reproduction 1999;14(10):2464‐70. - PubMed
Cucinella 2000 {published data only (unpublished sought but not used)}
    1. Cucinella G, Gugliotta G, Adile B. Total laparoscopic hysterectomy versus total abdominal hysterectomy: a confront of 100 versus 101 cases in prospective randomized study. XVI FIGO World Congress Abstract Book 3. Washington DC. 2000:45.
Davies 1998 {published data only (unpublished sought but not used)}
    1. Davies A. Randomized controlled trial comparing oophorectomy at vaginal and laparoscopically assisted vaginal hysterectomy. In: British Journal of Obstetrics and Gynaecology, poster abstract 1998.
Demir 2008 {published data only}
    1. Demir A, Bige O, Saatli B, Solak A, Saygili U, Önvural A. Prospective comparison of tissue trauma after laparoscopic hysterectomy types with retroperitoneal lateral transsection of uterine vessels using ligasure and abdominal hysterectomy. Archives of Gynecology and Obstetrics 2008;277:325‐30. - PubMed
Drahonovsky 2006 {published data only}
    1. Drahonovsky J, Pan M, Baresova S, Kucera E, Feyereisl J. Clinical comparison of laparoscopy‐assisted vaginal hysterectomy (LAVH) and total laparoscopy hysterectomy (TLH) in women with benign disease of uterus ‐ a prospective randomized study [Klinické srovnání laparoskopicky asistované vaginální hysterektomie (LAVH) a totální laparoskopické hysterektomie (TLH) u zen s benigním onemocnemím delohy ‐ prospektivní randomizovaná studie]. Ceska Gynekologie 2006;71(6):431‐7. - PubMed
Drahonovsky 2010 {published data only}
    1. Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. European Journal of Obstetrics & Gynecology and Reproductive Biology 2010;148:172‐6. - PubMed
Dua 2012 {published data only}
    1. Dua A, Galimberti A, Subramaniam M, Popli G, Radley S. The effects of vault drainage on postoperative morbidity after vaginal hysterectomy for benign gynaecological disease: a randomised controlled trial. BJOG 2012;119(3):348‐53. - PubMed
Ellstrom 2003 {published data only}
    1. Ellstrom MA, Astrom M, Moller A, Olsson JH, Hahlin M. A randomized trial comparing changes in psychological well‐being and sexuality after laparoscopic and abdominal hysterectomy. Acta Obstetrica et Gynaecologica Scandinavica 2003;82:871‐5. - PubMed
Fanfani 2013 {published data only}
    1. Fanfani F, Fagotti A, Gagliardi ML, Monterossi G, Rossitto C, Costantini B, et al. Minilaparoscopic versus single‐port total hysterectomy: a randomized trial. Journal of Minimally Invasive Gynecology 2013;20(2):192‐7. - PubMed
Ghanbari 2009 {published data only}
    1. Ghanbari Z, Baratali BH, Foroughifar T, Pesikhani MD, Shariat M. Pfannenstiel versus Maylard incision for gynecologic surgery: a randomized, double‐blind controlled trial. Taiwanese Journal of Obstetrics & Gynecology 2009;48(2):120‐3. - PubMed
Hahlin 1994 {published data only}
    1. Hahlin M, Ellstrom M, Olsson JH. Laparoscopic hysterectomy. Further knowledge of advantages and disadvantages is necessary. Lakartidningen 1994;91:220‐2. - PubMed
Holub 2000 {published data only}
    1. Holub Z, Jabor A, Kliment L, Voracek J, Lukac J. Comparison of two procedures for laparovaginal hysterectomy: a randomized trial. European Journal of Obstetrics and Gynecology 2000;90:31‐6. - PubMed
Horng 2004 {published data only}
    1. Horng SG, Huang KG, Lo TS, Soong YK. Bladder injury after LAVH: a prospective, randomized comparison of vaginal and laparoscopic approaches to colpotomy during LAVH. Journal of the American Association of Gynaecologic Laparoscopists 2004;11(1):42‐6. - PubMed
Howard 1993 {published data only}
    1. Howard FM, Sanchez R. A comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy. Journal of Gynecologic Surgery 1993;9(2):83‐9. - PubMed
Kim 2010 {published data only}
    1. Kim TK, Yoon JR. Comparison of the neuroendocrine and inflammatory responses after laparoscopic and abdominal hysterectomy. Korean Journal of Anesthesiology 2010;59(4):265‐9. - PMC - PubMed
Kucukozkan 2011 {published data only}
    1. Kucukozkan T, Ozkaya E, Ucar FO, Kara OF. Hysterectomy for large symptomatic myomas: minilaparotomy versus midline vertical incision. Archives of Gynecology and Obstetrics 2011;284(2):421‐5. - PubMed
Lee 2011 {published data only}
    1. Lee JH, Choi JS, Hong JH, Joo KJ, Kim BY. Does conventional or single port laparoscopically assisted vaginal hysterectomy affect female sexual function?. Acta Obstetricia et Gynecologica Scandinavica 2011;90(12):1410‐5. - PubMed
Li 2012 {published data only}
    1. Li M, Han Y, Feng YC. Single‐port laparoscopic hysterectomy versus conventional laparoscopic hysterectomy: a prospective randomized trial. Journal of International Medical Research 2012;40(2):701‐8. - PubMed
Long 2005 {published data only}
    1. Long CY, Liu CM, Wu TP, Hsu SC, Chang Y, Tsai EM. A randomized comparison of vesicourethral function after laparoscopic hysterectomy with and without vaginal cuff suspension. Journal of Minimally Invasive Gynecology 2005;12(2):137‐43. - PubMed
Morelli 2007 {published data only}
    1. Morelli M, Caruso M, Noia R, Chiodo D, Cosco C, Lucia E, et al. Total laparoscopic hysterectomy versus vaginal hysterectomy: a prospective randomized trial. Minerva Ginecologica 2007;59(2):99‐105. - PubMed
Moustafa 2008 {published data only}
    1. Moustafa M, Elgonaid WE, Massouh H, Beynon WG. Evaluation of closure versus non‐closure of vaginal vault after vaginal hysterectomy. Journal of Obstetrics and Gynaecology 2008;28(8):791‐4. - PubMed
Møller 2001 {published data only}
    1. Moeller C, Kehlet H, Schouenborg L, Ottensen B, Friland S, Lund C. Fast track hysterectomy. XVI FIGO World Congress Abstract Book 3. Washington DC, 2000:46.
    1. Møller C, Kehlet H, Friland SG, Schouenborg LO, Lund C, Ottesen B. Fast track hysterectomy. European Journal of Obstetrics & Gynecology and Reproductive Biology 2001;98:18‐22. - PubMed
Nezhat 1992 {published data only}
    1. Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal hysterectomy. Journal of Reproductive Medicine 1992;37(3):247‐50. - PubMed
Oscarsson 2006 {published data only}
    1. Oscarsson U, Poromaa IS, Nussler E, Lofgren M. No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy‐‐a preliminary study. Acta Obstetricia et Gynecologica Scandinavica 2006;85:682‐3. - PubMed
Pabuccu 1996 {published data only (unpublished sought but not used)}
    1. Pabuccu R, Atay V, Ergun A, Duru NK, Orhon E, Yenen MC. Laparoscopic assisted vaginal hysterectomy results. In: Human Reproduction: Abstracts of the 12th Annual Meeting of ESHRE. Maastricht 1996;11:235‐6.
Pan 2008 {published data only}
    1. Pan HS, Ko ML, Huang LW, Chang JZ, Hwang JL, Chen SC. Total laparoscopic hysterectomy (TLH) versus coagulation of uterine arteries (CUA) at their origin plus total laparoscopic hysterectomy (TLH) for the management of myoma and adenomyosis. Minimally Invasive Therapy 2008;17:318‐22. - PubMed
Park 2003 {published data only}
    1. Park NH, Kim JW, Seo CS, Kim SH, Song YS, Kang SB, et al. Comparison of two laparoscopic methods of hysterectomy. International Journal of Obstetrics and Gynecology 2003;83(Suppl 3):79.
Petrucco 1999 {published data only (unpublished sought but not used)}
    1. Petrucco OM, Luke C, Moss J, Healy D. Randomized prospective trial comparing laparoscopic assisted vaginal and abdominal hysterectomy. IX Annual Scientific Meeting of the Australian Gynaecological Endoscopic Society Abstracts. 1999:75.
Phipps 1993 {published data only}
    1. Phipps JH, John M, Nayak S. Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo‐ophorectomy with conventional abdominal hysterectomy and bilateral salpingo‐ophorectomy. British Journal of Obstetrics and Gynaecology 1993;100:698‐700. - PubMed
Seow 2010 {published data only}
    1. Seow KM, Lin YH, Hwang JL, Huang LW, Pan CP. A simple procedure to prevent chronic vaginal colpotomy wound bleeding after laparoscopically assisted vaginal hysterectomy. International Journal of Gynaecology and Obstetrics 2010;1091(1):49‐51. - PubMed
Yue 2009 {published data only}
    1. Yue Q, Ma R, Mao DW, Dong TJ, Sun L, Geng XX, et al. Effects of laparoscopically‐assisted vaginal hysterectomy compared with abdominal hysterectomy on immune function. Journal of International Medical Research 2009;37(3):855‐61. - PubMed

References to studies awaiting assessment

Sesti 2014 {published data only}
    1. Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Francesco L, et al. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Archives of Gynecology and Obstetrics 2014;290(3):485‐91. [DOI: 10.1007/s00404-014-3228-2] - DOI - PubMed

Additional references

ACOG 2009
    1. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 444. Choosing the Route of Hysterectomy for Benign Disease. Obstetrics & Gynecology 2009;114(5):1156–8. - PubMed
Agostini 2005
    1. Agostini A, Vejux N, Colette E, Bretelle F, Cravello L, Blanc B. Risk of bladder injury during vaginal hysterectomy in women with a previous cesarean section. Journal of Reproductive Medicine 2005;50(12):940‐2. - PubMed
Bijen 2009
    1. Bijen CB, Vermeulen KM, Mourits MJ, Bock GH. Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials. PLoS One 2009;4(10):e7340. - PMC - PubMed
Brummer 2008
    1. Brummer TH, Seppälä TT, Härkki PS. National learning curve for laparoscopic hysterectomy and trend in hysterectomy in Finland 2000‐2005. Human Reproduction 2008;23(4):840‐5. - PubMed
Brummer 2011
    1. Brummer TH, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Mäkinen J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Human Reproduction 2011;26(7):1741‐51. - PubMed
Dawson 2010
    1. Dawson J, Doll H, Fitzpatrick R, Jenkinson C, Carr AJ. The routine use of patient reported outcome measures in healthcare settings. BMJ 2010;340:c186. - PubMed
Ellstrom 1998b
    1. Ellstrøm M, Ferraz‐Nunes J, Hahlin M, Olsson J‐H. A randomized trial with a cost‐consequence analysis after laparoscopic and abdominal hysterectomy. Obstetrics and Gynecology 1998;91:30‐4. - PubMed
Flory 2005
    1. Flory N, Bissonnette F, Binik YM. Psychosocial effects of hysterectomy: literature review. Journal of Psychosomatic Research 2005;59(3):117‐29. - PubMed
Garry 1994
    1. Garry R, Reich H, Liu CY. Laparoscopic hysterectomy ‐ definitions and indications. Gynaecological Endoscopy 1994;3:1‐3.
Garry 1995
    1. Garry R, Phillips G. How safe is the laparoscopic approach to hysterectomy?. Gynaecological Endoscopy 1995;4:77‐9.
Garry 1998
    1. Garry R. Towards evidence‐based hysterectomy. Gynaecological Endoscopy 1998;7:225‐33.
Garry 2005
    1. Garry R. Health economics of hysterectomy. Best Practice & Research. Clinical Obstetrics & Gynaecology 2005;19(3):451‐65. - PubMed
Guyatt 2008
    1. Guyatt GH, Oxman AD, Vist G, Kunz R, Falck‐Ytter Y, Alonso‐Coello P, et al. for the GRADE Working Group. Rating quality of evidence and strength of recommendations GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924‐6. - PMC - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hoffmann 2014
    1. Hoffmann TC, Montori VM, Mar C. The connection between evidence‐based medicine and shared decision making. JAMA 2014;312(13):1295‐6. - PubMed
Johnson 2005b
    1. Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta‐analysis of randomised controlled trials. BMJ 2005;330(7506):1478‐85. - PMC - PubMed
Johnson 2009
    1. Johnson NP. Gynaecological surgery from art and craft to science?. Australian and New Zealand Journal of Obstetrics and Gynaecology 2009;49:120‐3. - PubMed
Khan 2014
    1. Khan K. The CROWN initiative: Journal editors invite researchers to develop core outcomes in women's health. Journal of Obstetrics and Gynaecology 2014;34(7):553‐4. - PubMed
Kovac 2014
    1. Kovac SR. Route of hysterectomy: an evidence‐based approach. Clinical Obstetrics and Gynecology 2014;57(1):58‐71. - PubMed
Lethaby 2012
    1. Lethaby A, Ivanova V, Johnson NP. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD004993.pub3] - DOI - PubMed
Lethaby 2013
    1. Lethaby A, Penninx J, Hickey M, Garry R, Marjoribanks J. Endometrial resection and ablation techniques for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2013, Issue 8. [DOI: 10.1002/14651858.CD001501.pub4] - DOI - PubMed
Lethaby 2015
    1. Lethaby A, Hussain M, Rishworth JR, Rees MC. Progesterone or progestogen‐releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database of Systematic Reviews 2015, Issue 4. [DOI: 10.1002/14651858.CD002126.pub3] - DOI - PubMed
Maresh 2002
    1. Maresh MJ, Metcalfe MA, McPherson K, Overton C, Hall V, Hargreaves J, et al. The VALUE national hysterectomy study: description of the patients and their surgery. BJOG 2002;109(3):302‐12. - PubMed
Moen 2014a
    1. Moen MD, Richter HE. Vaginal hysterectomy: the past, present and future. International Urogynecology Journal 2014;25(9):1161‐5. - PubMed
Moen 2014b
    1. Moen M, Walter A, Harmanli O, Cornella J, Nihira M, Gala R, Zimmerman C, Richter HE, Society of Gynecologic Surgeons Education Committee. Considerations to improve the evidence‐based use of vaginal hysterectomy in benign gynecology. Obstet Gynecol 2014;124(3):585‐588. - PubMed
Mäkinen 2001
    1. Mäkinen J, Johansson J, Tomás C, Tomás E, Heinonen PK, Laatikainen T, et al. Morbidity of 10 110 hysterectomies by type of approach. Human Reproduction 2001;16(7):1473‐8. - PubMed
Mäkinen 2013
    1. Mäkinen J, Brummer T, Jalkanen J, Heikkinen AM, Fraser J, Tomás E, et al. Ten years of progress‐‐improved hysterectomy outcomes in Finland 1996‐2006: a longitudinal observation study. BMJ Open 2013;3(10):e003169. - PMC - PubMed
Nezhat 1995
    1. Nezhat C, Nezhat F, Admon D, Nezhat AA. Proposed classification of hysterectomies involving hysterectomy. Journal of the American Association of Gynecologic Laparoscopists 1995;2:427‐9. - PubMed
Orozco 2014
    1. Orozco LJ, Salazar A, Clarke J, Tristan M. Hysterectomy versus hysterectomy plus oophorectomy for premenopausal women. Cochrane Database of Systematic Reviews 2014, Issue 7. [DOI: 10.1002/14651858.CD005638.pub3] - DOI - PMC - PubMed
Pynnä 2014
    1. Pynnä K, Vuorela P, Lodenius L, Paavonen J, Roine RP, Räsänen P. Cost‐effectiveness of hysterectomy for benign gynecological conditions: a systematic review. Acta Obstetricia et Gynecologica Scandinavica 2014;93(3):225‐32. - PubMed
Reich 1989
    1. Reich H, Decaprio J, McGlynn F. Laparoscopic hysterectomy. Journal of Gynecological Surgery 1989;5:213‐6.
Reich 2003
    1. Reich H, Roberts L. Laparoscopic hysterectomy in current gynaecological practice. Reviews in Gynaecological Practice 2003;3:32‐40.
Sarlos 2010
    1. Sarlos D, Kots L, Stevanovic N, Schaer G. Robotic hysterectomy versus conventional laparoscopic hysterectomy: outcome and cost analyses of a matched case‐control study. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2010;150(1):92‐6. - PubMed
Sculpher 2004
    1. Sculpher M, Manca A, Abbott J, Fountain J, Mason S, Garry R. Cost effectiveness analysis of laparoscopic hysterectomy compared with standard hysterectomy: results from a randomised trial. BMJ 2004;328(7432):134. - PMC - PubMed
Smorgick 2014
    1. Smorgick N, As‐Sanie S. The benefits and challenges of robotic‐assisted hysterectomy. Current Opinion in Obstetrics and Gynecology 2014;26(4):290‐4. - PubMed
Spencer 1999
    1. Spencer CP, Whitehead MI. Endometrial assessment re‐visited. BJOG 1999;106(7):623‐32. - PubMed
Spilsbury 2006
    1. Spilsbury K, Semmens JB, Hammond I, Bolck A. Persistent high rates of hysterectomy in Western Australia: a population based study of 83 000 procedures over 23 years. British Journal of Obstetrics and Gynaecology 2006;113(7):804‐9. - PubMed
Sutton 1997
    1. Sutton C. Hysterectomy: a historical perspective. Balliere's Clinical Obstetrics & Gynaecology 1997;11:1‐22. - PubMed
Tapper 2014
    1. Tapper AM, Hannola M, Zeitlin R, Isojärvi J, Sintonen H, Ikonen TS. A systematic review and cost analysis of robot‐assisted hysterectomy in malignant and benign conditions. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2014;177:1‐10. - PubMed
Twijnstra 2012
    1. Twijnstra AR, Blikkendaal MD, Zwet EW, Kesteren PJ, Kroon CD, Jansen FW. Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstetrics and Gynecology 2012;119(4):700‐8. - PubMed
Vessey 1992
    1. Vessey MP, Villard‐Mackintosh I, McPherson K. The epidemiology of hysterectomy findings in a large cohort study. British Journal of Obstetrics and Gynaecology 1992;99:402‐7. - PubMed

References to other published versions of this review

Johnson 2002
    1. Johnson N, Lethaby A, Farquhar C, Garry R, Barlow D. Surgical approaches to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews 2002, Issue 4. [DOI: 10.1002/14651858] - DOI
Johnson 2005
    1. Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews 2005, Issue 1. [DOI: 10.1002/14651858.CD003677.pub2] - DOI - PubMed
Johnson 2006
    1. Nieboer TE, Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD003677.pub3] - DOI - PubMed
Nieboer 2009
    1. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database of Systematic Reviews 2009, Issue 3. [DOI: 10.1002/14651858.CD003677.pub4] - DOI - PubMed