Study designs of evaluations included in the review
Studies of laparoscopy-assisted vaginal hysterectomy which used the double-puncture technique and which described complications. Case reports, abstracts and letters were excluded.
Specific interventions included in the review
Laparoscopy-assisted vaginal hysterectomy, total abdominal hysterectomy (TAH) and vaginal hysterectomy. Laparoscopy-assisted vaginal hysterectomy was classified into 5 types: type 0, use of the laparoscope for examination only; type 1, lysis of adhesions; type 2, ligation of the utero-ovarian or infundibulopelvic vessels; type 3, ligation of the uterine vessels; and type 4, laparoscopic dissection including cardinal and uterosacral ligaments.
The authors excluded studies of laparoscopy-assisted vaginal hysterectomy used for radical cancer treatment, sex-change operations, total laparoscopic procedures, or supra-cervical procedures.
Participants included in the review
Patients undergoing hysterectomy. Patients undergoing laparoscopy-assisted vaginal hysterectomy had a weighted grand mean age of 45 compared to a weighted grand mean age of 42 years for TAH. Body weight grand mean was 154 pounds for laparoscopy-assisted vaginal hysterectomy (23 studies reporting) and 165 for TAH (3 studies reporting). Weighted grand mean uterine weight for laparoscopy-assisted vaginal hysterectomy was 152 grams and 227 grams for TAH. Eleven studies included nulliparous women and ten studies included women who had previous Caesarean deliveries.
Outcomes assessed in the review
The otcomes assessed were:
1. Major complications (bladder injury, blood transfusions, bowel injury, fistula, ureteral trauma, pulmonary embolus, and sepsis).
2. Minor complications (urinary tract infection, epigastric vessel injury, cuff cellulitis, pelvic haematoma, respiratory infection, wound infection, and subcutaneous emphysema.
3. Operating time.
4. Pain relief requirements.
5. Return to work information.
6. Costs.
7. Conversion to open laparotomy for completion.
How were decisions on the relevance of primary studies made?
The authors do not state how the papers were selected for the review, or how many of the authors performed the selection.