Five RCTs (n=663 women, range 40 to 400) were included in the review. Three of the included trials were of moderate quality (Jadad score 2 or 3). Two trials were of low quality (Jadad score 0 or 1).
There were no significant differences in perioperative complication rates (total or by grade; five RCTs), rates of urinary tract infection (five RCTs), rates of conversion to laparotomy (three RCTs), or operative blood loss (three studies) between vaginal hysterectomy and total laparoscopic hysterectomy. There was no evidence of significant heterogeneity in any data set.
Total laparoscopic hysterectomy was associated with significantly longer operating times (WMD 29.31 minutes, 95% CI 13.33 to 45.30; five RCTs; statistically significant between trial heterogeneity).
Compared with vaginal hysterectomy, total laparoscopic hysterectomy was associated with significantly shorter post-operative stay (WMD -0.62 days, 95% CI -0.89 to -0.35; four RCTs; no evidence of significant heterogeneity) and lower postoperative pain scores (VAS) on the day of surgery (WMD -2.13, 95% CI -4.08 to-0.18; three RCTs; significant between trial heterogeneity).