Laparoscopic Hysterectomy for Benign Gynecological Diseases: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

HE Hongying ¹ ,  LI Li ² , CHEN Jianghong ¹ , LI Jingjing ¹ , TANG Yizhong ¹ , ZHONG Hua ¹

1. Department of Gynaecology and Obstetrics, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, China;2. Department of Gynaecological Oncology, Cancer Institute and Hospital of Guangxi Medical University, Nanning 530021, China;

Corresponding author：

LI Li, Email: lili_temp@hotmail.com

Keywords：

Laparoscopic hysterectomy (LH); Abdominal hysterectomy (AH); Benign gynecological disease; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20130013

Video：

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Objective 　To assess the safety and effectiveness of laparoscopic hysterectomy (LH) for women with benign gynecological diseases.
Methods 　Such databases as CENTRAL (The Cochrane Library, Issue 5, 2012), MEDLINE, EMbase, CNKI, WanFang Data, VIP and CBM were searched from the date of their establishment to May 2012, meanwhile the relevant gray literature was also retrieved to identify the randomized controlled trials (RCTs) about LH versus abdominal hysterectomy (AH) for benign gynecological diseases. The literature was screened according to the inclusion and exclusion criteria by two reviewers independently, and the methodology quality was evaluated after extracting the data, then RevMan 5.1 software was used for meta-analysis.
Results 　A total of 22 RCTs involving 3 304 patients were included. The results of meta-analysis showed that, compared with AH, LH was shorter in the time of both hospital stay (MD=–2.31, 95%CI –3.03 to –1.60, P lt;0.000 01) and postoperative recovery (MD=−13.86, 95%CI −17.70 to −10.03, P lt;0.000 01), and lower in the incidences of both postoperative fever and other nonspecific infections (OR=0.72, 95%CI 0.54 to 0.95, P=0.02), but it was higher in the incidence rate of intraoperative urinary systematic injuries (OR=2.41, 95%CI 1.21 to 4.82, P=0.012), and longer in the operation time (MD=20.27, 95%CI 3.95 to 36.59, P=0.03). There were no significant differences between the two groups in the incidence of complications such as intraoperative intestinal injuries, vessel injuries, postoperative fistulizaion, postoperative urethral dysfunction, postoperative vaginal infection, etc. (P gt;0.05).
Conclusion 　This systematic review shows when treating benign gynecological diseases, LH is superior to AH in shortening the time of hospital stay and postoperative recovery, and in decreasing the incidence of operative fever and other nonspecific infections, but it results in a higher incidence of intraoperative urinary systematic injuries and longer operative time. Because there is no result regarding to the postoperative long-term life quality, so it expects to be further proved by more high quality RCTs.

Citation： HE Hongying,LI Li,CHEN Jianghong,LI Jingjing,TANG Yizhong,ZHONG Hua. Laparoscopic Hysterectomy for Benign Gynecological Diseases: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2013, 13(1): 62-69. doi: 10.7507/1672-2531.20130013 Copy

1.	Wu JM, Wechter ME, Geller EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol, 2007, 110(5): 1091-1095.
2.	Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol, 2008, 198(1): 34 -37.
3.	Clayton RD. Hysterectomy. Best Pract Res Clin Obstet Gynaecol, 2006, 20(1): 73-87.
4.	Reich H, DeCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gyneco Surg, 1989, (5): 213-216.
5.	Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol, 2007, 19(4): 337-344.
6.	Reich H, Roberts L. Laparoscopic hysterectomy in current gynecological practice. Reviews in Gynaecological Practice, 2003, (3): 32-40.
7.	Johns DA, Carrera B, Jones J, et al. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital. Am J Obstet Gynecol, 1995, 6(172): 1715-1719.
8.	Johnson N, Barlow D, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev, 2006, (2): CD003677.
9.	Brill AI. Hysterectomy in the 21st century: different approaches, different challenges. Clin Obstet Gynecol, 2006, 49(4): 722-735.
10.	Garry R, Fountain J, Mason S, 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.
11.	Englund M, Robson S. Why has the acceptance of laparoscopic hysterectomy been slow? Results of an anonymous survey of Australian gynecologists. J Minim Invasive Gynecol, 2007, 14(6): 724-728.
12.	Johnson N, Barlow D, Lethaby A, et al. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ, 2005, 330(7506): 1478.
13.	Kluivers, Riphagen I, Vierhout ME, et al. Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review. Eur J Obstet Gynecol Reprod Biol, 2008, 136(1): 3-8.
14.	Raju KS, Auld BJ. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy. Br J Obstet Gynaecol, 1994, 101(12): 1068-1071.
15.	Kunz G, Plath T, Leyendecker G. [Comparison of laparoscopically assisted vaginal hysterectomy with abdominal hysterectomy. Technique and results]. Geburtshilfe Frauenheilkd, 1996, 56(9): 453-457.
16.	Langebrekke A, Eraker R, Nesheim BI, et al. 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(4): 404-407.
17.	Olsson JH, Ellstrom M, Hahlin M, et al. A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol, 1996, 103(4): 345-350.
18.	Ellström M, Olsén MF, Olsson JH, et al. Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study. Acta Obstet Gynecol Scand, 1998, 77(9): 923-928.
19.	Summitt RL, Stovall TG, Steege JF, et al. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates. Obstet Gynecol, 1998, 92(3): 321-326.
20.	Yuen PM, Mak TW, Yim SF, et al. Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Am J Obstet Gynecol, 1998, 179(1): 1-5.
21.	Falcone T, Paraiso MF, Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J Obstet Gynecol, 1999, 180(4): 955-962.
22.	Marana R, Busacca M, Zupi E, et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Am J Obstet Gynecol, 1999, 180(2 Pt 1): 270-275.
23.	Perino A, Cucinella G, Venezia R, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod, 1999, 14(12): 2996-2999.
24.	Ferrari M, Berlanda N, Mezzopane R, et al. Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids. BJOG, 2000, 107(5):620-625.
25.	Harkki-Siren P, Sjoberg J, Toivonen J, et al. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand, 2000, 79(10): 866-871.
26.	Lumsden MA, Twaddle S, Hawthorn R, et al. A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. BJOG, 2000, 107(11): 1386-1391.
27.	Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG, 2000, 107(11): 1380-1385.
28.	Hwang JL, Seow KM, Tsai YL, et al. 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(12): 1132-1138.
29.	Schutz K, Possover M, Merker A, et al. 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(1): 121-125.
30.	Seracchioli R, Venturoli S, Vianello F, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc, 2002, 9(3): 333-338.
31.	Ribeiro SC, Ribeiro RM, Santos NC, et al. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet, 2003, 83(1): 37-43.
32.	Tsai EM, Chen HS, Long CY, et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section. Gynecol Obstet Invest, 2003, 55(2): 105-109.
33.	Persson P, Wijma K, Hammar M, et al. Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study. BJOG, 2006, 113(9): 1023-1030.
34.	Kluivers KB, Mol BW, Bremer GL, et al. Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy. J Minim Invasive Gynecol, 2007, 14(4): 442-448.
35.	Garry R, PG. How safe is the laparoscopic approach to hysterectomy? Gynaecological Endoscopy, 1995, 4: 77-79.
36.	Härkki-Sirén P, Sjöberg J, Mäkinen J, et al. Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations. Am J Obstet Gynecol, 1997, 176(1 Pt 1): 118-122.
37.	Wattiez A, Soriano D, Cohen SB, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc, 2002, 9(3): 339-345.
38.	Kluivers KB, Hendriks JC, Mol BW, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol, 2007, 14(2): 145-152.
39.	Chien P, Khan K, Mol BW. How to interpret the findings of the eVALuate study. BJOG, 2005, 112(4): 391-393.
40.	Kluivers KB, Riphagen I, Vierhout ME, et al. Systematic review on recovery specific quality-of-life instruments. Surgery, 2008, 143(2): 206-215.

1. Wu JM, Wechter ME, Geller EJ, et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol, 2007, 110(5): 1091-1095.
2. Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol, 2008, 198(1): 34 -37.
3. Clayton RD. Hysterectomy. Best Pract Res Clin Obstet Gynaecol, 2006, 20(1): 73-87.
4. Reich H, DeCaprio J, McGlynn F. Laparoscopic hysterectomy. J Gyneco Surg, 1989, (5): 213-216.
5. Reich H. Total laparoscopic hysterectomy: indications, techniques and outcomes. Curr Opin Obstet Gynecol, 2007, 19(4): 337-344.
6. Reich H, Roberts L. Laparoscopic hysterectomy in current gynecological practice. Reviews in Gynaecological Practice, 2003, (3): 32-40.
7. Johns DA, Carrera B, Jones J, et al. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, not-for-profit hospital. Am J Obstet Gynecol, 1995, 6(172): 1715-1719.
8. Johnson N, Barlow D, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev, 2006, (2): CD003677.
9. Brill AI. Hysterectomy in the 21st century: different approaches, different challenges. Clin Obstet Gynecol, 2006, 49(4): 722-735.
10. Garry R, Fountain J, Mason S, 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.
11. Englund M, Robson S. Why has the acceptance of laparoscopic hysterectomy been slow? Results of an anonymous survey of Australian gynecologists. J Minim Invasive Gynecol, 2007, 14(6): 724-728.
12. Johnson N, Barlow D, Lethaby A, et al. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ, 2005, 330(7506): 1478.
13. Kluivers, Riphagen I, Vierhout ME, et al. Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review. Eur J Obstet Gynecol Reprod Biol, 2008, 136(1): 3-8.
14. Raju KS, Auld BJ. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo-oophorectomy. Br J Obstet Gynaecol, 1994, 101(12): 1068-1071.
15. Kunz G, Plath T, Leyendecker G. [Comparison of laparoscopically assisted vaginal hysterectomy with abdominal hysterectomy. Technique and results]. Geburtshilfe Frauenheilkd, 1996, 56(9): 453-457.
16. Langebrekke A, Eraker R, Nesheim BI, et al. 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(4): 404-407.
17. Olsson JH, Ellstrom M, Hahlin M, et al. A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol, 1996, 103(4): 345-350.
18. Ellström M, Olsén MF, Olsson JH, et al. Pain and pulmonary function following laparoscopic and abdominal hysterectomy: a randomized study. Acta Obstet Gynecol Scand, 1998, 77(9): 923-928.
19. Summitt RL, Stovall TG, Steege JF, et al. A multicenter randomized comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy in abdominal hysterectomy candidates. Obstet Gynecol, 1998, 92(3): 321-326.
20. Yuen PM, Mak TW, Yim SF, et al. Metabolic and inflammatory responses after laparoscopic and abdominal hysterectomy. Am J Obstet Gynecol, 1998, 179(1): 1-5.
21. Falcone T, Paraiso MF, Mascha E. Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy. Am J Obstet Gynecol, 1999, 180(4): 955-962.
22. Marana R, Busacca M, Zupi E, et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a prospective, randomized, multicenter study. Am J Obstet Gynecol, 1999, 180(2 Pt 1): 270-275.
23. Perino A, Cucinella G, Venezia R, et al. Total laparoscopic hysterectomy versus total abdominal hysterectomy: an assessment of the learning curve in a prospective randomized study. Hum Reprod, 1999, 14(12): 2996-2999.
24. Ferrari M, Berlanda N, Mezzopane R, et al. Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids. BJOG, 2000, 107(5):620-625.
25. Harkki-Siren P, Sjoberg J, Toivonen J, et al. Clinical outcome and tissue trauma after laparoscopic and abdominal hysterectomy: a randomized controlled study. Acta Obstet Gynecol Scand, 2000, 79(10): 866-871.
26. Lumsden MA, Twaddle S, Hawthorn R, et al. A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. BJOG, 2000, 107(11): 1386-1391.
27. Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG, 2000, 107(11): 1380-1385.
28. Hwang JL, Seow KM, Tsai YL, et al. 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(12): 1132-1138.
29. Schutz K, Possover M, Merker A, et al. 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(1): 121-125.
30. Seracchioli R, Venturoli S, Vianello F, et al. Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus. J Am Assoc Gynecol Laparosc, 2002, 9(3): 333-338.
31. Ribeiro SC, Ribeiro RM, Santos NC, et al. A randomized study of total abdominal, vaginal and laparoscopic hysterectomy. Int J Gynaecol Obstet, 2003, 83(1): 37-43.
32. Tsai EM, Chen HS, Long CY, et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: a study of 100 cases on light-endorsed transvaginal section. Gynecol Obstet Invest, 2003, 55(2): 105-109.
33. Persson P, Wijma K, Hammar M, et al. Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study. BJOG, 2006, 113(9): 1023-1030.
34. Kluivers KB, Mol BW, Bremer GL, et al. Pelvic organ function in randomized patients undergoing laparoscopic or abdominal hysterectomy. J Minim Invasive Gynecol, 2007, 14(4): 442-448.
35. Garry R, PG. How safe is the laparoscopic approach to hysterectomy? Gynaecological Endoscopy, 1995, 4: 77-79.
36. Härkki-Sirén P, Sjöberg J, Mäkinen J, et al. Finnish national register of laparoscopic hysterectomies: a review and complications of 1165 operations. Am J Obstet Gynecol, 1997, 176(1 Pt 1): 118-122.
37. Wattiez A, Soriano D, Cohen SB, et al. The learning curve of total laparoscopic hysterectomy: comparative analysis of 1647 cases. J Am Assoc Gynecol Laparosc, 2002, 9(3): 339-345.
38. Kluivers KB, Hendriks JC, Mol BW, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol, 2007, 14(2): 145-152.
39. Chien P, Khan K, Mol BW. How to interpret the findings of the eVALuate study. BJOG, 2005, 112(4): 391-393.
40. Kluivers KB, Riphagen I, Vierhout ME, et al. Systematic review on recovery specific quality-of-life instruments. Surgery, 2008, 143(2): 206-215.

Chinese Journal of Evidence-Based Medicine

Laparoscopic Hysterectomy for Benign Gynecological Diseases: A Systematic Review

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