Laparoscopic Assisted Vaginal Hysterectomy Verses Abdominal Hysterectomy: A systematic review and metanalysis

OBJECTIVE To examine studies that explored the differences between laparoscopic assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in endometrial cancer (EC) patients, and to determine which surgical intervention has better outcomes. DATA SOURCES Electronic search of the following databases was performed; Google Scholar, PubMed/Medline, Wiley, Web of Science, Cochrane Library, Embase, and EBSCO Host. METHODS of STUDY SELECTION All full English articles in the form of randomized controlled trials (RCT), prospective cohort (PC), and retrospective cohort (RC) comparing LAVH and TAH outcomes in endometrial cancer patients was included in this study. A complete search of the literature comparing the outcomes of LAVH and AH in EC patients. This study was registered in PROSPERO [ID: CRD42021225509] and follows PRISMA and MOOSE guidelines. Outcomes included length of hospital stay, surgical duration, complications, blood transfusion requirements, and blood loss. TABULATION ROBINS-1, ROB 2.0, and ROBVIS was used to assess the risk of bias. Statistical tests used included relative risk (RR) for dichotomous and standard mean difference (SMD) for continuous variable. A P value less than 0.05 was considered significant. A forest plot was used to visually demonstrate the analyses for all outcomes. INTEGRATION and RESULTS A total of 13 articles (total cohort n=14,803) were included in the systematic review and metanalysis. The total cohort for LAVH patients was n=1845 and n=12,958 for TAH. Patients who underwent a TAH had significantly higher risk of complications [RR = 0.547, p< 0.001], greater risk for blood transfusion [RR = 0.349, p< 0.033], more blood loss [SMD = −3.256, p< 0.001], and longer hospital stay [SMD = −1.351, p< 0.001]. LAVH patients had longer operating time [SMD= 1.103, p< 0.001] compared TAH patients. CONCLUSION LAVH presented with lower of hospital stay, complications, amount of blood loss, and blood transfusion requirements when compared to TAH. LAVH in the appropriate setting and skills may be a safer alternative than TAH.