Abstract：
OBJECTIVE: To provide available evidence comparing surgical outcomes of different vaginal hysterectomy (VH) techniques and devices.
METHODS: PubMed, Embase, and ClinicalTrials.gov databases were searched from inception to December 1, 2023, using relevant keywords.
METHODS: Studies comparing at least 2 surgical techniques and devices for VH were included. An arm-based random effect frequentist network meta-analysis was performed. All available surgical outcomes were evaluated.
RESULTS: Ten randomized controlled trials and 7 observational studies were eligible reporting on 1577 women undergoing VH with different techniques and devices (50% conventional, 22.5% Ligasure, 17.3% BiClamp, and 9.2% transvaginal natural orifice transluminal endoscopic surgery [vNOTES]). All surgical techniques/devices had a comparable risk ratio (RR) in terms of intraoperative complications, but Clavien-Dindo grade III postoperative complications were significantly reduced in the vNOTES group (RR, 0.15; 95% confidence interval [CI], 0.03-0.82; I2 = 0%) compared with conventional VH. The pooled network analysis showed a lower standard mean deviation for blood loss when comparing energy-based vessel sealing technologies (Ligasure: standard mean deviation, -0.92; 95% CI, -1.47 to -0.37; BiClamp: standard mean deviation, -1.66; 95% CI, -2.77 to -0.55) with conventional VH. Total operative time, postoperative hemoglobin variation, and pain were significantly reduced only in the Ligasure group compared with conventional VH. Bilateral salpingectomy or bilateral salpingo-oophorectomy was most commonly performed in the vNOTES group (RR, 1.9; 95% CI, 1.17-3.10) compared with the conventional VH group.
CONCLUSIONS: Modern surgical techniques/devices have the potential to improve anatomic exposure and to reduce morbidity of VH. This may drive resurgence of vaginal approach to hysterectomy.
METHODS: PubMed, Embase, and ClinicalTrials.gov databases were searched from inception to December 1, 2023, using relevant keywords.
METHODS: Studies comparing at least 2 surgical techniques and devices for VH were included. An arm-based random effect frequentist network meta-analysis was performed. All available surgical outcomes were evaluated.
RESULTS: Ten randomized controlled trials and 7 observational studies were eligible reporting on 1577 women undergoing VH with different techniques and devices (50% conventional, 22.5% Ligasure, 17.3% BiClamp, and 9.2% transvaginal natural orifice transluminal endoscopic surgery [vNOTES]). All surgical techniques/devices had a comparable risk ratio (RR) in terms of intraoperative complications, but Clavien-Dindo grade III postoperative complications were significantly reduced in the vNOTES group (RR, 0.15; 95% confidence interval [CI], 0.03-0.82; I2 = 0%) compared with conventional VH. The pooled network analysis showed a lower standard mean deviation for blood loss when comparing energy-based vessel sealing technologies (Ligasure: standard mean deviation, -0.92; 95% CI, -1.47 to -0.37; BiClamp: standard mean deviation, -1.66; 95% CI, -2.77 to -0.55) with conventional VH. Total operative time, postoperative hemoglobin variation, and pain were significantly reduced only in the Ligasure group compared with conventional VH. Bilateral salpingectomy or bilateral salpingo-oophorectomy was most commonly performed in the vNOTES group (RR, 1.9; 95% CI, 1.17-3.10) compared with the conventional VH group.
CONCLUSIONS: Modern surgical techniques/devices have the potential to improve anatomic exposure and to reduce morbidity of VH. This may drive resurgence of vaginal approach to hysterectomy.
摘要：
目的：提供现有证据，比较不同阴式子宫切除术（VH）技术和装置的手术结果。
方法：发布，从开始到2023年12月1日，使用相关关键字搜索Embase和ClinicalTrials.gov数据库。
方法：包括比较至少两种用于VH的手术技术和装置的研究。进行了基于arm的随机效应频率网络荟萃分析。评估所有可用的手术结果。
结果：10项随机对照试验和7项观察性研究符合资格，报告了1,577名使用不同技术和设备接受VH的妇女（50％常规，22.5%Ligasure®,17.3%BiClamp®,和9.2％自然腔道内镜手术-vNOTES）。所有手术技术/装置在术中并发症方面具有相当的风险比。但与常规VH相比,vNOTES组Clavien-DindoIII级术后并发症显著减少(风险比0.15;95%CI,0.03~0.82;I2=0%)。汇总网络分析显示，与常规VH相比，在比较基于能量的血管密封技术时，失血的标准平均偏差较低（Ligasure®：标准平均偏差-0.92；95％CI，-1.47至-0.37；BiClamp®：标准平均偏差-1.66；95％CI，-2.77至-0.55）。总手术时间,与常规VH相比,仅Ligasure®组的术后血红蛋白变异和疼痛显著减少。与常规VH组相比，vNOTES组最常进行双侧输卵管切除术或双侧输卵管卵巢切除术（风险比1.9；95％CI，1.17至3.10）。
结论：现代外科技术/器械有可能改善VH的解剖暴露并降低其发病率。这可能会促使子宫切除术的阴道方法复活。
方法：发布，从开始到2023年12月1日，使用相关关键字搜索Embase和ClinicalTrials.gov数据库。
方法：包括比较至少两种用于VH的手术技术和装置的研究。进行了基于arm的随机效应频率网络荟萃分析。评估所有可用的手术结果。
结果：10项随机对照试验和7项观察性研究符合资格，报告了1,577名使用不同技术和设备接受VH的妇女（50％常规，22.5%Ligasure®,17.3%BiClamp®,和9.2％自然腔道内镜手术-vNOTES）。所有手术技术/装置在术中并发症方面具有相当的风险比。但与常规VH相比,vNOTES组Clavien-DindoIII级术后并发症显著减少(风险比0.15;95%CI,0.03~0.82;I2=0%)。汇总网络分析显示，与常规VH相比，在比较基于能量的血管密封技术时，失血的标准平均偏差较低（Ligasure®：标准平均偏差-0.92；95％CI，-1.47至-0.37；BiClamp®：标准平均偏差-1.66；95％CI，-2.77至-0.55）。总手术时间,与常规VH相比,仅Ligasure®组的术后血红蛋白变异和疼痛显著减少。与常规VH组相比，vNOTES组最常进行双侧输卵管切除术或双侧输卵管卵巢切除术（风险比1.9；95％CI，1.17至3.10）。
结论：现代外科技术/器械有可能改善VH的解剖暴露并降低其发病率。这可能会促使子宫切除术的阴道方法复活。
