Effect of transcutaneous electrical acupoint stimulation on recovery following gynecological laparoscopic surgery: a meta-analysis.

This meta-analysis has been registered in the PROSPERO systematic review registry (CRD420251165053). We searched the following databases: CNKI, Wanfang, VIP, Embase, Web of Science, PubMed, and The Cochrane Library to collect RCTs on TEAS for gynecological laparoscopic surgeries. The search was conducted up to September 24, 2025. This study employed a combination of subject headings and free-text terms for the search, using keywords including “transcutaneous electrical acupoint stimulation”, “transcutaneous acupoint electrical stimulation”,“TEAS”,“TAES”,“Laparoscopy”,“Laparoscopies”,“Peritoneoscopy”,“Peritoneoscopies”,“Celioscopy”,“Celioscopies”,“Laparoscopic Assisted Surgery”.“Laparoscopic Assisted Surgeries”,“Laparoscopic Surgical Procedure”,“Laparoscopic Surgery”,“Laparoscopic Surgeries”, “Laparoscopic Surgical Procedures”. For example, the complete detection strategy for PubMed is presented in Supplementary Material Table 1. Inclusion Criteria: Study Design: RCTs. Participants: Females aged > 18 years undergoing gynecological laparoscopic surgery. Experimental group utilised TEAS stimulation (with no restrictions on acupoint selection, frequency, duration, or treatment course), while the control group received sham stimulation or conventional treatment. Usual care mainly involved conventional postoperative management methods, while sham TEAS primarily involved placing electrode patches on the corresponding acupoints without delivering stimulation. Outcome measures: Primary outcomes: postoperative pain (VAS) and incidence of PONV. Secondary outcomes: time to first flatus, first defecation, bowel sound recovery, QoR-15, MMSE. Pain intensity was assessed using the Visual Analogue Scale (VAS), with total scores ranging from 0 to 10, where higher scores indicated more severe pain. PONV incidence was included as a postoperative binary outcome. Furthermore, the quality of early postoperative recovery was measured using the Quality of Recovery-15 (QoR-15) questionnaire, which comprises 15 items—including pain assessment, psychological evaluation, and functional assessment—each scored from 0 to 10. The total score ranges from 0 to 150, with higher scores reflecting better recovery. Finally, cognitive function was evaluated using the Mini-Mental State Examination (MMSE), which is scored out of 30 points, where lower scores indicate more severe cognitive impairment. Study Design: RCTs. Participants: Females aged > 18 years undergoing gynecological laparoscopic surgery. Experimental group utilised TEAS stimulation (with no restrictions on acupoint selection, frequency, duration, or treatment course), while the control group received sham stimulation or conventional treatment. Usual care mainly involved conventional postoperative management methods, while sham TEAS primarily involved placing electrode patches on the corresponding acupoints without delivering stimulation. Outcome measures: Primary outcomes: postoperative pain (VAS) and incidence of PONV. Secondary outcomes: time to first flatus, first defecation, bowel sound recovery, QoR-15, MMSE. Pain intensity was assessed using the Visual Analogue Scale (VAS), with total scores ranging from 0 to 10, where higher scores indicated more severe pain. PONV incidence was included as a postoperative binary outcome. Furthermore, the quality of early postoperative recovery was measured using the Quality of Recovery-15 (QoR-15) questionnaire, which comprises 15 items—including pain assessment, psychological evaluation, and functional assessment—each scored from 0 to 10. The total score ranges from 0 to 150, with higher scores reflecting better recovery. Finally, cognitive function was evaluated using the Mini-Mental State Examination (MMSE), which is scored out of 30 points, where lower scores indicate more severe cognitive impairment. Exclusion criteria: Patients undergoing non-gynecological laparoscopic surgery. Studies where full-text access or relevant outcome measures could not be obtained. Conference proceedings and abstract-only papers. Duplicate publications. Case reports, protocol studies, reviews, and animal experiments. Patients undergoing non-gynecological laparoscopic surgery. Studies where full-text access or relevant outcome measures could not be obtained. Conference proceedings and abstract-only papers. Duplicate publications. Case reports, protocol studies, reviews, and animal experiments. Two researchers (KW and SYX) screened the literature in EndNote X9 using set criteria. They resolved any disagreements through discussion or by consulting a third researcher (HYZ). Extracted information included study details, author, year, age range, and sample sizes. TEAS details (frequency, intensity, duration), control interventions, outcomes, and quality assessment elements (e.g., randomisation, blinding, reporting) were recorded. If the standard deviation (SD) was missing, we used conversion formulas to calculate it. For unclear or missing data, we contacted the original authors. Two researchers (KW and SYX) assessed risk of bias using the Cochrane risk-of-bias tool for randomized trials (RoB 1). Assessment components included: (1) random sequence generation, (2) allocation concealment, (3) blinding of participants, (4) blinding of outcome assessors, (5) incomplete outcome data, (6) selective reporting, (7) other factors potentially introducing bias. Based on the appropriateness of the study methodologies in the included literature, the quality assessment results were classified as “high risk,” “low risk,” or “unclear.” The two researchers (KW and SYX) independently rated the risk of bias as “low,” “unclear,” or “high.” Any disagreements were resolved through discussion with a third researcher (HYZ). Statistical analysis was conducted using Stata 15.0 and Review Manager 5.4 software. Continuous outcomes (VAS, time to first flatus, defecation, and bowel sound recovery, QoR-15, MMSE score) were pooled as mean differences (MDs) with 95% confidence intervals (CIs), and binary variables were pooled as risk ratios (RRs) with 95% CIs. Heterogeneity among studies was assessed using Cochran’s chi-squared test (Cochran’s Q) and I² tests. When I 2  > 50% and P  ≤ 0.10, significant heterogeneity was indicated. In these cases, a random-effects model was applied, with between-study variance estimated using the DerSimonian–Laird method. Subgroup analysis was conducted to identify and explore potential causes of significant heterogeneity. If I 2   0.10, a fixed-effects model was chosen for analysis [ 21 ]. Leave-one-out sensitivity analyses were performed for outcomes with substantial heterogeneity to examine the robustness of pooled estimates. Publication bias was assessed using funnel plots and Egger’s test for outcomes with at least 10 studies. P -values less than 0.05 indicated a higher likelihood of publication bias. When asymmetry was suspected, trimming methods were used to estimate the number and impact of potentially missing studies. For outcomes with fewer than 10 studies, funnel plots and Egger’s test were considered exploratory.

Based on the inclusion and exclusion criteria, we conducted an initial search across the following databases: CNKI ( n  = 18), Wanfang ( n  = 19), VIP ( n  = 29), PubMed ( n  = 35), Embase ( n  = 71), Cochrane Library ( n  = 124), and Web of Science ( n  = 123), yielding a total of 419 records. Prior to formal screening, we excluded 74 records automatically identified as ineligible, 68 duplicate records, and 216 records excluded for other reasons, leaving 61 records in the database. After reviewing titles and abstracts, we excluded 22 records that did not meet the criteria, leaving 39 for full-text eligibility assessment. Following a detailed full-text review, we excluded 9 records: 6 for lacking relevant outcome measures and 3 for unusable data. For example, XQ Yin (2013) presented only trend graphs without reporting specific numerical data [ 22 ]. L Zhou (2025) employed a combined intervention of acupoint injection and electrical stimulation, precluding isolation of the independent effect of TEAS [ 23 ]. W Wei (2020) reported lung function measures exclusively and omitted primary outcomes, such as the VAS and PONV incidence [ 24 ]. YY Pan (2023) used the Quality of Recovery-40 (QoR-40) questionnaire to assess postoperative recovery quality [ 25 ]. Ultimately, thirty studies were included in the meta-analysis [ 18 , 19 , 23 , 26 – 52 ]. The literature search flow diagram is presented in Fig.  1 . Fig. 1 Flowchart of Literature Screening Flowchart of Literature Screening Table  1 summarizes the basic characteristics of the thirty included trials. These trials involved 2573 patients undergoing gynecological laparoscopic surgery and had an age range of 18–70 years. Among them, 1286 patients were assigned to the TEAS group and 1287 to the control group. These trials were published between 2013 and 2025, with sample sizes ranging from 20 to 100. Regarding TEAS stimulation parameters, a frequency of 2/100 Hz was the most commonly used. Currents were mostly below 15 mA. The most frequent treatment duration was 30 min. Among the TEAS treatment protocols, 22 studies selected the Neiguan (PC6) acupoint, whereas 8 did not. Outcome measures included the VAS, incidence of PONV, time to first flatus, defecation, bowel sound recovery, QoR-15, and MMSE score. Among the included studies, twelve trials used VAS as an outcome measure. In addition, Twenty-one trials reported the incidence of PONV. Twelve trials recorded the time to first flatus. Six trials measured the time to first defecation. Four trials evaluated the time to recovery of bowel sounds. Three trials employed the QoR-15, and three trials utilized the MMSE score. Table 1  Basic Characteristics of Literature Study Year Sample size Mean age(years) Intervention Outcomes EG CG EG CG EG CG PC6 BX Bing 2016 30 30 42. 8 ± 3. 6 41. 9 ± 3. 1 TEAS: 0.02HZ 30-50 mA 30 min/once Usual care NO ① K Chen 2025 30 30 42.6 ± 8.8 41.7 ± 9.1 TEAS: 2/10Hz 30 min/once Sham TEAS Yes ①②⑥ L Deng 2013 100 100 33.6 ± 8.5 34.0 ± 8.8 TEAS: 2–100 Hz Sham TEAS Yes ①② T Fu 2023 33 33 42.7 ± 11.0 38.3 ± 10.4 TEAS: 2/100Hz 6-15 mA, 30 min/once Sham TEAS Yes ③④⑤⑥ YF Gao 2018 30 30 35.40 ± 8.45 35.30 ± 9.21 TEAS: 2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. Usual care Yes ② JS Huang 2015 50 50 35.0 ± 5.6 34.5 ± 5.7 TEAS: 2 Hz < 2 mA 30 min/once Usual care NO ①②③④ L Huang 2020 50 50 50.76 ± 7.42 49.31 ± 8.34 TEAS: 2/100Hz < 5 mA Sham TEAS Yes ② LY Liang 2022 50 50 52.18 ± 9.48 52.06 ± 10.49 TEAS: 20–40 min/once Usual care Yes ③ X Lin 2020 30 30 38.3 ± 7.9 35.23 ± 7.8 TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once Usual care Yes ①②③⑤ DG Liu 2024 30 30 41.07 ± 3.52 41.80 ± 5.93 TEAS:4–20 Hz 30 min/once Sham TEAS Yes ① JJ Liu 2024 45 45 35.18 ± 8.69 36.72 ± 10.26 TEAS: 2–100 Hz < 5 mA Sham TEAS NO ③ Q Mao 2025 48 48 40.85 ± 5.30 41.36 ± 5.19 TEAS: 2 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once Sham TEAS NO ② YA Wang 2015 58 58 34.9 ± 5.4 34.7 ± 5.6 TEAS: 2 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once Usual care NO ①②③④ YR Wei 2017 30 30 24–52 age 24–52 age TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. Sham TEAS NO ① W Wei 2016 20 20 55.2 ± 6.14 56.5 ± 4.59 TEAS:2/100Hz 2 V 30 min/once Sham TEAS Yes ⑦ W Wei 2017 20 20 57.10 ± 4.19 57.55 ± 4.13 TEAS2:100 Hz 2 V 1 h/once Sham TEAS Yes ⑦ B Wu 2020 30 30 40.8 ± 4.24 40.8 ± 4.24 TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. Sham TEAS NO ② X Yang 2024 50 50 59.5 ± 9.4 58.3 ± 9.1 TEAS: 2/100Hz 12-15 mA 30 min/once Usual care Yes ①⑦ ZL Yang 2015 30 30 18–60 age 18–60 age TEAS: 30 min Sham TEAS Yes ②③⑤ H Yuan 2021 60 60 32.12 ± 3.31 32.47 ± 3.28 32.32 ± 3.23 TENS short: 2/100Hz TENS long: 2/100Hz Usual care Yes ①③④⑤ WX Zhang 2020 30 30 45–70 age 45–70 age TEAS:10–20 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once Usual care Yes ②③④ RZ Zheng 2018 66 66 48.70 ± 8.54 51.60 ± 10.33 TEAS: 2/100Hz 30-80 mA Sham TEAS Yes ② ZH Zhou 2025 50 50 43.92 ± 8.84 40.98 ± 7.90 TEAS:2/10Hz 10-15 mA 30 min/once Sham TEAS Yes ①②③⑥ YS Yao 2015 35 36 34.2 ± 7.2 35.6 ± 8.7 TEAS: 2/10Hz 6-9 mA 30 min/once Sham TEAS Yes ② XY Yang 2015 50 50 40.33 ± 26.67 40.33 ± 26.67 TEAS: 2 Hz 1 mA Usual care NO ② XD Yu 2020 30 30 48.5 ± 16.2 45.9 ± 17.5 TEAS:2/100Hz 12-15 mA 30 min/once Sham TEAS Yes ①② MM Wang 2025 40 40 40.88 ± 10.19 39.27 ± 10.28 TEAS: 40–50 Hz Sham TEAS Yes ② L Zhou 2025 40 40 46.8 ± 10.1 49.1 ± 9.7 TEAS: 2/100 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once Sham TEAS Yes ② LD Jin 2025 40 40 34.8 ± 6.9 33.8 ± 6.5 TEAS: 2/ 100 Hz 6-10 mA 30 min/once Sham TEAS Yes ②③④ JZ Qin 2022 81 81 45 ± 7.45 45 ± 5.92 TEAS: 2/100 Hz 1-12 mA Sham TEAS Yes ②③ PC6 Neiguan acupoint, Sham TEAS Placing electrode patches on the corresponding acupoints without delivering stimulation, Usual care Conventional postoperative management methods ① VAS: Visual analogue scale ② PONV: Postoperative nausea and vomiting ③ Postoperative flatus time ④ Postoperative defecation time ⑤ Bowel sound recovery time ⑥ QoR-15: Quality of Requirements-15 ⑦ MMSE: Mini mental status examination Basic Characteristics of Literature TEAS: 0.02HZ 30-50 mA 30 min/once TEAS: 2/10Hz 30 min/once TEAS: 2/100Hz 6-15 mA, 30 min/once TEAS: 2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. TEAS: 2 Hz < 2 mA 30 min/once TEAS: 2/100Hz < 5 mA TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once TEAS:4–20 Hz 30 min/once TEAS: 2–100 Hz < 5 mA TEAS: 2 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once TEAS: 2 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. TEAS:2/100Hz 2 V 30 min/once TEAS2:100 Hz 2 V 1 h/once TEAS:2/100Hz The current was raised from the lowest level to the patient’s tolerance limit. TEAS: 2/100Hz 12-15 mA 30 min/once 32.12 ± 3.31 32.47 ± 3.28 TENS short: 2/100Hz TENS long: 2/100Hz TEAS:10–20 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once TEAS: 2/100Hz 30-80 mA TEAS:2/10Hz 10-15 mA 30 min/once TEAS: 2/10Hz 6-9 mA 30 min/once TEAS: 2 Hz 1 mA TEAS:2/100Hz 12-15 mA 30 min/once TEAS: 2/100 Hz The current was raised from the lowest level to the patient’s tolerance limit. 30 min/once TEAS: 2/ 100 Hz 6-10 mA 30 min/once TEAS: 2/100 Hz 1-12 mA PC6 Neiguan acupoint, Sham TEAS Placing electrode patches on the corresponding acupoints without delivering stimulation, Usual care Conventional postoperative management methods ① VAS: Visual analogue scale ② PONV: Postoperative nausea and vomiting ③ Postoperative flatus time ④ Postoperative defecation time ⑤ Bowel sound recovery time ⑥ QoR-15: Quality of Requirements-15 ⑦ MMSE: Mini mental status examination A total of sixteen trials described detailed randomization methods, among which seven trials employed random number tables and eight followed computer-generated random sequences. Furthermore, five trials reported allocation concealment, and five implemented blinding of participants and personnel. Additionally, seven trials mentioned blinding of outcome assessors. Studies that did not explicitly report blinding were assessed as having an unclear risk of bias. Similarly, other biases were also frequently reported as unclear. (Supplementary Material 1 figures s1–s2). Overall, the methodological quality of the included trials was moderate to low, mainly because allocation concealment and blinding were insufficiently reported in many studies. This study included twelve investigations that employed the VAS as the outcome measure. Eight studies reported postoperative pain scores at 6 h, exhibiting substantial heterogeneity (I² = 94.3%, P  < 0.001), necessitating analysis using a random-effects model. Results indicated that TEAS significantly reduced postoperative 6-hour pain scores in patients undergoing gynecological laparoscopic surgery [MD = -0.64, 95% CI (-1.17, -0.12),95% PI (− 2.37, 1.08)]. Four studies reported pain scores at 12 h postoperatively, again exhibiting substantial heterogeneity (I² = 90.7%, P  < 0.001). Analysis using a random-effects model indicated that TEAS significantly reduced pain scores at 12 h postoperatively [MD = -0.85, 95% CI (-1.35, -0.35),95% PI (− 2.55, 0.84)]. Twelve studies reported postoperative 24-hour pain scores. Despite substantial heterogeneity (I² = 96.9%, P  < 0.001), the random-effects model indicated TEAS significantly alleviated pain at 24 h [MD = -0.92, 95% CI (-1.29, -0.55),95% PI (− 2.13, 0.30)]. Furthermore, five studies reported pain scores at 48 h post-surgery (I² = 94.1%, P  < 0.001). Random-effects model analysis indicated that TEAS continued to reduce pain scores at 48 h post-surgery [MD = -0.75, 95% CI (-1.30, -0.20),95% PI (− 2.35, 0.85)] (Fig.  2 ). Fig. 2 Meta-analysis forest plot of Visual Analogue Scale (VAS) Meta-analysis forest plot of Visual Analogue Scale (VAS) Twenty-one studies reported the incidence of PONV. Given the low heterogeneity (I² = 1.3%, P  > 0.10), a fixed-effect model was employed for analysis. As a result, TEAS significantly reduced the incidence of PONV in gynecological laparoscopy patients compared with the control group [RR = 0.50, 95% CI (0.44, 0.57)] (Fig.  3 A). Furthermore, subgroup analysis demonstrated TEAS efficacy in alleviating both nausea [RR = 0.51, 95% CI (0.42, 0.62)] and vomiting [RR = 0.41, 95% CI (0.28, 0.60)] (Fig.  3 B). Fig. 3 Meta-analysis forest plot of Postoperative nausea and vomiting (PONV). A Overall PONV forest plot; ( B ) Subgroup analysis of PONV Meta-analysis forest plot of Postoperative nausea and vomiting (PONV). A Overall PONV forest plot; ( B ) Subgroup analysis of PONV Twelve trials in this study reported the time to first flatus. Due to substantial heterogeneity (I² = 97.1%, P  < 0.001), a random-effects model was employed in the analysis. The results indicated that TEAS significantly shortened the time to first flatus in gynecological laparoscopic surgery patients [MD = − 7.52, 95% CI (− 10.17, − 4.87),95% PI (− 18.77, 3.73)] (Fig.  4 ). Fig. 4 Meta-analysis forest plot of time to first flatus postoperatively Meta-analysis forest plot of time to first flatus postoperatively Six studies reported the time of the first defecation.The random-effects model demonstrated that TEAS significantly shortened the time to first defecation compared to the control group [MD = -15.12, 95% CI (-21.97, -8.26),95% PI (− 43.64, 13.21)] (Fig.  5 ). Fig. 5 Meta-analysis forest plot of time to first defecation postoperatively Meta-analysis forest plot of time to first defecation postoperatively Four studies reported the time to recovery of bowel sounds, encompassing 426 subjects. Based on random-effects model analysis, TEAS significantly shortened the time to first bowel sound recovery [MD = -4.80, 95% CI (-7.67, -1.93),95% PI (− 16.51, 6.82)] (Fig.  6 ). Fig. 6 Meta-analysis forest plot of time to bowel sound recovery Meta-analysis forest plot of time to bowel sound recovery Three studies utilised the QoR-15 score, encompassing 226 subjects. The random-effects model demonstrated a significant increase in QoR-15 scores following TEAS compared to the control group [MD = 2.87, 95% CI (1.15, 4.60),95% PI (− 2.01, 7.72)] (Fig.  7 A). Subgroup analysis revealed that TEAS yielded higher QoR-15 scores at 24 h postoperatively compared with 48 h postoperatively in gynecological laparoscopy patients [MD = 1.59, 95% CI (0.28, 2.90),PI (− 2.89, 6.07)] (Fig.  7 B). Fig. 7 Meta-analysis forest plot of Quality of Recovery-15 (QoR-15). A Overall QoR-15 forest plot; ( B ) Subgroup analysis of QoR-15 Meta-analysis forest plot of Quality of Recovery-15 (QoR-15). A Overall QoR-15 forest plot; ( B ) Subgroup analysis of QoR-15 Three studies utilized the MMSE score, encompassing 180 subjects. Due to significant heterogeneity (I 2 = 93.5%, P  < 0.001), a random-effects model was applied for analysis. The results demonstrated a significant increase in MMSE scores following TEAS compared with the control group [MD = 1.80, 95% CI (0.40, 3.19),95% PI (− 4.52, 8.11)] (Fig.  8 ). Fig. 8 Meta-analysis forest plot of Mini-Mental State Examination (MMSE) Meta-analysis forest plot of Mini-Mental State Examination (MMSE) To further explore sources of heterogeneity, we conducted subgroup analyses stratified by TEAS timing (preoperative/intraoperative/postoperative) and by whether the PC6 acupoint was included, with respect to the primary outcome measures. For the primary outcome of postoperative pain, subgroup analyses showed that the pooled effect for studies including PC6 was [MD = -0.60, 95% CI (-0.95, -0.26), I²= 97.3%, P  < 0.001], whereas the pooled effect for studies excluding PC6 was [MD= -1.06, 95% CI (-1.25, -0.88), I 2  = 72.7%, P  < 0.001]. We performed subgroup analyses based on the timing of TEAS implementation, with results showing that the pooled effect in the postoperative TEAS subgroup was [MD = − 1.08, 95% CI (-1.72, -0.43),I 2  = 95.4%, P  < 0.001], while the pooled effect in the preoperative subgroup was [MD = − 0.72, 95% CI (-1.01, -0.43, I 2  = 44.6%, P  < 0.001)]. In addition, we uniformly classified cross-phase interventions, such as those extending from the preoperative period to the intraoperative or postoperative period, as well as those from the intraoperative to the postoperative period, under the category of combined perioperative. The pooled effect in this combined perioperative subgroup was [MD = − 0.74, 95% CI (-1.01, -0.47),I 2  = 96.1%, P  < 0.001] (Supplementary Material 1 figures s3–s4). Additionally, we performed subgroup analyses for time to first flatus, defecation, bowel sound recovery, QoR-15. The corresponding subgroup forest plots are presented in Supplementary Material 1 (Supplementary Material 1 figures s5–s11). Several continuous outcomes showed substantial heterogeneity (VAS, time to first flatus, defecation, bowel sound recovery, QoR-15, and MMSE scores). Therefore, sensitivity analysis was performed, and the pooled results remained generally stable. Additionally, funnel plots and Egger’s test were used to evaluate publication bias for VAS scores, incidence of PONV, time to first flatus, defecation, bowel sound recovery, QoR-15, and MMSE scores. Egger’s test showed VAS ( P  = 0.468) and time to first flatus ( P  = 0.699). In contrast, for PONV, funnel plot asymmetry was observed, and Egger’s test was significant ( P  < 0.001), indicating that publication bias could not be excluded. However, further analysis using the trim-and-fill method indicated that publication bias had minimal impact, and the results remained robust. Finally, publication bias assessments for outcomes with fewer than 10 studies (time to first defecation, bowel sound recovery time, QoR-15, and MMSE) were considered exploratory and are presented in the Supplementary Material (Supplementary Material 1 figures s12–s18).

Gynecological laparoscopic surgery is a minimally invasive technique characterized by small incisions, minimal blood loss, and rapid postoperative recovery. Due to these advantages, it has recently gained widespread use in the treatment of various gynecological conditions, including uterine fibroids, ovarian cysts, and endometriosis [ 1 ]. However, postoperative pain [ 2 ], nausea and vomiting, and gastrointestinal dysfunction [ 3 ] remain common complications in gynecological laparoscopic surgery. The study found that the incidence rates of grade Ⅲ resting pain and post-activity pain at 24 h postoperatively were 42% and 74%, respectively [ 4 ]. Generally, postoperative pain is associated with diaphragmatic irritation by residual carbon dioxide pneumoperitoneum and visceral traction, with visceral pain being more pronounced than surgical incision pain [ 5 ].Gastrointestinal dysfunction is a common complication following gynecological laparoscopic surgery, characterized by symptoms such as nausea, vomiting, abdominal distension and fullness, abdominal pain, delayed recovery of bowel sounds, and postponed defecation and flatulence. In severe cases, it may progress to intestinal adhesions and postoperative ileus [ 6 ]. Postoperative nausea and vomiting (PONV) occur most often within 48 h after surgery, with an overall incidence of 30% [ 7 ]. The incidence of PONV ranges from 20.0% to 57.1%, with 33.8% occurring within 6 h and 39.7% within 24 h after surgery [ 8 ]. PONV causes fluid and electrolyte imbalances, wound dehiscence, esophageal injury, and increased intracranial pressure. It also limits postoperative analgesia use, leading to drug wastage, longer hospital stays, and lower quality of care. Currently, opioids are commonly used in clinical practice for postoperative pain management [ 9 ]. Measures such as fluid support and gastrointestinal decompression are implemented postoperatively to prevent gastrointestinal dysfunction by reducing surgical trauma [ 10 ]. Additionally, for postoperative cognitive dysfunction, pharmacological interventions primarily include acetylcholinesterase inhibitors, NMDA receptor antagonists, and statins [ 11 ]. However, these treatments may lead to adverse reactions such as respiratory depression, sedation, nausea, vomiting, and constipation, which can subsequently prolong hospital stays and impair patient experience [ 12 ]. Therefore, identifying non-pharmacological intervention strategies to enhance the efficiency of postoperative functional recovery is particularly important. Transcutaneous electrical acupoint stimulation (TEAS), which integrates traditional Chinese medicine theory with modern electrical stimulation technology, has demonstrated significant efficacy in promoting postoperative recovery and reducing postoperative complications. It has now become an essential component of perioperative management [ 13 ]. TEAS is a non-invasive acupoint-based electrical stimulation intervention. This technique involves attaching painless cutaneous electrodes to specific acupoints, where electrical stimulation modulates visceral function and balances the yin-yang dynamics [ 14 ]. Compared to traditional acupuncture, TEAS offers distinct advantages, including non-invasiveness, reduced risk of infection, and simplified operational procedures. Chi et al. demonstrated that TEAS alleviates postoperative pain and enhances recovery in elderly patients undergoing knee arthroplasty by regulating stress hormones and inflammatory cytokines, thereby suppressing stress and inflammatory responses [ 15 ]. Chen et al. further revealed that integrating TEAS with enteral nutrition effectively mitigates gastrointestinal symptoms, improves feeding efficiency, and accelerates rehabilitation in patients following cerebrovascular surgery [ 16 ]. Meanwhile, TEAS can enhance the quality of postoperative recovery in patients undergoing nasal endoscopic surgery, alleviate postoperative pain, improve sleep quality after surgery, and reduce the incidence of PONV [ 17 ]. Yu et al. found that preoperative TEAS administration improved the quality of early postoperative recovery in patients undergoing gynecological laparoscopic surgery [ 18 ]. Jin et al. demonstrated that multiple sessions of TEAS effectively alleviated pain after gynecological laparoscopic surgery, reduced the need for rescue antiemetics, and promoted the recovery of postoperative intestinal function [ 19 ]. Therefore, TEAS shows potential in reducing postoperative pain and PONV, as well as promoting gastrointestinal function recovery following gynecological laparoscopic surgery. Although the number of randomised controlled trials (RCTs) on TEAS for post-operative complications following gynecological laparoscopy is increasing, its therapeutic benefits remain controversial. Previous studies found that TEAS alleviates pain and promotes gastrointestinal recovery after surgery [ 20 ]. However, no comprehensive analysis has yet examined the effects of TEAS on postoperative pain, nausea and vomiting, time to first flatus and defecation, recovery of bowel sounds, and cognition scores after gynecological laparoscopy. This study aims to clarify the efficacy of TEAS in postoperative recovery after gynecological laparoscopic surgery, thereby providing a new therapeutic option for reducing postoperative complications.

In summary, TEAS may improve several postoperative recovery outcomes after gynecological laparoscopic surgery, particularly pain, PONV, and gastrointestinal recovery. However, given the heterogeneity of the available evidence and the methodological limitations of the included trials, the current findings should be interpreted as supportive rather than definitive. Larger, rigorously designed, multicentre RCTs are required to clarify the magnitude of benefit and identify the optimal stimulation protocol.

In minimally invasive gynecological surgery, optimisation of perioperative recovery remains a major clinical concern. Although advances in surgical techniques have improved patient outcomes, differences in core perioperative outcomes across surgical approaches may still be modest. A recent RCT-only systematic review with GRADE assessment comparing robotic-assisted and conventional laparoscopic total hysterectomy for benign gynecological disease reported broadly comparable operative and perioperative outcomes between the two techniques, with only a slightly shorter length of hospital stay in the robotic group. Given the substantial cost differential, conventional laparoscopy remained a clinically equivalent option for most patients. Against this background, adjunctive perioperative strategies that further enhance recovery after gynecological laparoscopy are of considerable clinical importance [ 53 ]. Although similar articles have been published in previous studies [ 20 , 54 , 55 ], most have focused on single indicators, such as VAS, the incidence of PONV, or time to first flatus. This study comprehensively evaluated the effects of TEAS on postoperative pain (VAS), gastrointestinal function (nausea and vomiting, time to first flatus, defecation, and bowel sound recovery), quality of recovery (QoR-15), and cognitive function (MMSE) following gynecological laparoscopy. The results demonstrated that TEAS may be associated with lower VAS scores and PONV incidence, shorter time to gastrointestinal recovery, and improved QoR-15 and MMSE scores in patients undergoing gynecological laparoscopy. Furthermore, Meng et al. published a protocol for a systematic review of TEAS for postoperative pain after laparoscopy. The study included all patients undergoing laparoscopic surgery and did not perform subgroup analyses at different postoperative time points [ 56 ]. This study systematically analysed VAS scores at 6, 12, 24, and 48 h post-surgery. It demonstrated that TEAS was associated with lower pooled pain scores across postoperative time points, with the pooled reduction in pain appeared numerically greatest at 24 h. Although the analgesic effect gradually diminished over time, it remained effective at 48 h post-surgery. This suggests that TEAS not only reduces early acute pain but also delays the decline in analgesic efficacy. Postoperative pain is generally categorised into wound pain, visceral pain, and inflammatory pain, with its pathogenesis linked to the activation of peripheral nociceptors and central nervous system sensitisation [ 57 ]. When tissue injury occurs, and inflammatory mediators are released, the sensitivity of nociceptors to afferent signals increases, leading to peripheral sensitisation. Central sensitisation amplifies pain signals by influencing spinal neurons. Activation of nociceptive primary afferents also triggers NMDAR activation, enhancing synaptic function and inducing calcium influx [ 58 ]. Both forms of sensitization depend on inflammatory factor-mediated neural regulation. Unlike peripheral sensitization, central sensitization primarily induces secondary hyperalgesia [ 59 ]. Research indicates that TEAS may alleviate pain by activating multiple bioactive molecules in peripheral and central systems, with the endogenous opioid system playing a crucial role in TEAS analgesia [ 60 ]. The sparse-dense wave stimulation pattern of TEAS induces simultaneous release of enkephalins and dynorphins, enhancing therapeutic efficacy [ 61 ]. In this study, the control group received conventional treatment and sham TEAS stimulation. In the present review, pooled estimates indicated lower postoperative VAS scores in the TEAS group than in the control group. This finding suggests that TEAS may have an analgesic benefit when used as an adjunct to conventional anaesthesia. TEAS exhibited the most pronounced analgesic effect at 24 h post-surgery. Subgroup analyses at different time points revealed across postoperative time points, the pooled reduction in pain appeared numerically greatest at 24 h. Although the analgesic effect subsequently diminished, pain relief persisted up to 48 h post-surgery. Consistent with our findings, Lee et al. observed that electroacupuncture alleviated pain at various time points following hysterectomy, with the most significant reduction occurring within the first 24 h post-surgery [ 62 ]. The accumulation of local tissue mediators such as ATP/bradykinin, prostaglandins, and cytokines induced by the surgical incision peaks between 12 and 24 h postoperatively. The most pronounced analgesic effect of TEAS within the first 24 h may be attributed to its inhibition of pain signal transmission in the dorsal column nuclei and thalamus, activation of the endogenous opioid system to promote β-endorphin release, reduction in the release of inflammatory mediators, and alleviation of pain-related stress states. Postoperative cognitive impairment shows as inattention, memory deficits, cognitive disorganisation, and reduced learning capacity [ 63 ]. Neuroinflammation is a core pathogenic mechanism underlying postoperative cognitive dysfunction. Surgical trauma and anaesthetic agents can allow pro-inflammatory cytokines to cross the blood-brain barrier. This passage triggers a cascade of inflammation in the central nervous system. At the same time, this inflammatory response leads to neuronal cell death, or apoptosis. The release of danger-associated molecular patterns further activates microglia. This activity exacerbates neuroinflammation and impairs cognitive functions, including learning and memory [ 64 , 65 ]. Some scholars suggest that TEAS may reduce the incidence of postoperative cognitive impairment. It may work by regulating cholinergic neurotransmitters, reducing inflammation, balancing the autonomic nervous system, and inhibiting apoptosis [ 66 ]. The present study’s analysis indicates that TEAS increases MMSE scores in gynecological laparoscopic surgery patients with an average age of 45.9–59.5 years. This finding suggests a potential beneficial effect of TEAS on postoperative cognitive recovery in middle-aged and older patients undergoing gynecological surgery. This finding is consistent with the research by Liu et al. [ 67 ] Evidence regarding cognitive recovery remains preliminary, with only three small studies available and substantial heterogeneity. The further high-quality trials are needed before firm conclusions can be drawn. PONV represents a complex physiological response arising from the sustained interaction between the gastrointestinal tract, enteric nervous system, central nervous system, and autonomic nervous system [ 68 ]. Its regulatory mechanisms involve neurotransmitters, their receptors, and neural circuits. Exogenous stimuli may trigger the release of emetogenic neurotransmitters, which activate 5-HT [ 69 ], NK-1R [ 70 ], opioid µ and κ receptors [ 71 ], muscarinic M₁ [ 72 ], and histamine H₁receptors [ 73 ], thereby eliciting nausea and vomiting. Furthermore, postoperative gastrointestinal dysfunction manifests as delayed flatus and stool passage, abdominal distension, and other symptoms. Acupuncture possesses unique advantages in treating postoperative gastrointestinal dysfunction [ 74 ]. Multiple studies indicate that TEAS effectively reduces postoperative nausea and vomiting while accelerating gastrointestinal and overall recovery [ 25 , 26 ]. Its mechanism may involve activation of the brain-gut axis, regulation of autonomic function, and anti-inflammatory effects [ 75 ]. Egger’s test revealed a significant bias in the incidence of PONV ( P  < 0.001). We hypothesise that this bias arises because studies with significant results and small sample sizes are more likely to be published, whereas negative findings may remain unreported. Concurrently, inconsistencies in TEAS intervention parameters (current intensity, frequency, acupoint selection, timing of application, and treatment frequency) across studies may amplify the effects of small-sample research. However, trim-and-fill analysis indicates a limited number of potentially missing studies with minimal impact on the overall findings. Consistent with previous findings, this study demonstrates that TEAS can alleviate pain, reduce postoperative nausea and vomiting, and improve gastrointestinal and cognitive function. The substantial heterogeneity observed in several continuous outcomes may be attributable to factors such as anesthesia, analgesic medications, and variations in the TEAS implementation protocol. First, selection and dosage of anesthetic and analgesic agents, as well as the administration of prophylactic antiemetic measures, varied across studies, potentially influencing therapeutic outcomes. Second, substantial differences in the timing of TEAS application, including the intervention window (preoperative, postoperative, or continuous from preoperative to postoperative), acupoint selection, stimulation frequency, current intensity, and treatment duration, also varied. In particular, whether the PC6 was selected or combined with other acupoints may have affected PONV and gastrointestinal function outcomes. Furthermore, inconsistencies in the timing of outcome assessment, especially for the VAS, contributed to heterogeneity. These methodological and clinical differences may partly explain the variability in effect estimates. In addition, the prediction intervals for several continuous outcomes crossed the null, suggesting that although the average pooled effect favored TEAS, the direction and magnitude of effect may vary across clinical settings. The strengths of this study lie in its comprehensive analysis of the effects of TEAS on postoperative pain, quality of recovery, gastrointestinal function, and cognitive function in patients undergoing gynecological laparoscopic surgery. Sensitivity analyses were employed to assess the robustness of findings, whilst funnel plots and Egger’s test evaluated publication bias. Subgroup analyses further examined VAS and QoR-15 scores at different time points, which may help inform future trial design and clinical interpretation. Nevertheless, this study retains several limitations. However, several limitations should also be acknowledged. First, only studies published in Chinese and English were included, possibly leading to incomplete evidence retrieval and language bias. Second, methodological quality varied, with some trials insufficiently reporting allocation concealment and blinding, increasing bias risk and affecting reliability. Third, substantial between-study heterogeneity may reflect differences in TEAS-related factors, such as stimulation frequency, current intensity, treatment duration, and acupoint selection. Although 2/100 Hz, current intensity below 15 mA, and 30-minute sessions were most common, this review focused on TEAS’s overall efficacy rather than the optimal protocol. Therefore, the current evidence does not support firm recommendations on the most effective parameter combination. Fourth, most included RCTs were from China, possibly limiting generalizability and increasing the risk of publication bias. Finally, outcomes with few studies may have insufficient statistical power for publication bias assessments. Results should be interpreted cautiously. Future well-designed, adequately powered multicenter RCTs should directly compare stimulation parameters to optimize the TEAS regimen for clinical use. In recent years, Enhanced Recovery After Surgery (ERAS) has emerged as a novel model for perioperative medical management. Its core principle is to reduce surgical stress, thereby lowering complications, speeding recovery, shortening hospital stays, and reducing healthcare costs [ 76 ]. As ERAS principles advance, ‘perioperative acupuncture medicine’ has gained attention for its use of acupuncture throughout the perioperative period to expedite recovery and enhance long-term outcomes [ 77 ]. TEAS is a promising non-pharmacological adjunct within ERAS pathways and may contribute to improvements in postoperative comfort and recovery.

Supplementary Material 1. Supplementary Material 1.