Abdominal Hysterectomy with a Uterine Manipulator Minimizes Vaginal Shortening: A Randomized Controlled Trial

Abstract

Background: We aimed to investigate the impact of adopting an uterine manipulator (UM) on the postoperative (VL) and female sexual function index (FSFI) in patients undergoing abdominal hysterectomy (AH) for benign gynecological disease.

Materials and methods: Hysterectomies were performed with the Richardson technique; two variations, a UM or digital guidance, in this technique were used during the colpotomy step. Subjects were randomized and allocated to either hysterectomy with UM guidance (study group) or conventional hysterectomy (control group). Pre- and postoperative VL and FSFI were recorded for each patient. Additionally, surgeons' and residents' satisfaction in locating the colpotomy site was also scored by the surgical team postoperatively.

Results: There was a significant reduction in the VL (10.2 ± 1.2 cm vs. 8.3 ± 0.7 cm, p < 0.001) and FSFI score (21.0 ± 4.1 to 17.1 ± 3.6, p < 0.001) between the pre-operation stage and three months post-operation in the control group. However, no such significant changes were observed in the study group. Additionally, surgeons' and residents' satisfaction scores (SSS) for locating the colpotomy site were significantly higher in the study group as compared to the control group (p < 0.001).

Conclusion: Our findings revealed that implementation of an UM in AH prevented unintended shortening of the postoperative VL and avoided a decline in the sexual function as compared to the standard AH procedure. These benefits were probably due to the precise determination of the colpotomy site that resulted from the use of UM in AH.

Keywords: Hysterectomy; female sexual function; uterine manipulator; vaginal length.