Sarah Namee Wambete, Dorcas Serwaa, Edem Kojo Dzantor, Ararso Baru, Evelyn Poku-Agyemang, Margaret Wekem Kukeba, Yussif Bashiru, Oladapo O Olayemi
Determinants for male involvement in family planning and contraception in Nakawa Division, Kampala, Uganda; An urban slum qualitative study
PLOS global public health
four approaches hysterectomy benign disease abdominal hysterectomy ah vaginal hysterectomy vh laparoscopic hysterectomy lh roboticassisted hysterectomy rhto assess effectiveness safety different surgical approaches hysterectomy women benign gynaecological conditionswe searched following databases inception 14 august 2014 using ovid platform cochrane central register controlled trials central medline embase cumulative index nursing allied health literature cinahl psycinfo also searched relevant citation lists used indexed freetext termswe included randomised controlled trials rcts clinical outcomes compared one surgical approach hysterectomy anotherat least two review authors independently selected trials assessed risk bias performed data extraction primary outcomes return normal activities satisfaction quality life intraoperative visceral injury major longterm complications ie fistula pelviabdominal pain urinary dysfunction bowel dysfunction pelvic floor condition sexual dysfunctionwe included 47 studies 5102 women evidence comparisons low moderate quality main limitations poor reporting imprecision vaginal hysterectomy vh versus abdominal hysterectomy ah nine rcts 762 womenreturn normal activities shorter vh group mean difference md 95 days 95 confidence interval ci 126 64 three rcts 176 women i2 75 moderate quality evidence evidence difference groups primary outcomes laparoscopic hysterectomy lh versus ah 25 rcts 2983 womenreturn normal activities shorter lh group md 136 days 95 ci 154 118 six rcts 520 women i2 71 low quality evidence urinary tract injuries lh group odds ratio 24 95 ci 12 48 13 rcts 2140 women i2 0 low quality evidence evidence difference groups primary outcomes lh versus vh 16 rcts 1440 womenthere evidence difference groups primary outcomes roboticassisted hysterectomy rh versus lh two rcts 152 womenthere evidence difference groups primary outcomes neither studies reported satisfaction rates quality lifeoverall number adverse events low included studiesamong women undergoing hysterectomy benign disease vh appears superior lh ah associated faster return normal activities technically feasible vh performed preference ah rapid recovery fewer febrile episodes postoperatively vh possible lh advantages ah including rapid recovery fewer febrile episodes wound abdominal wall infections offset longer operating time advantages lh vh could found lh longer operation time total laparoscopic hysterectomy tlh urinary tract injuries three subcategories lh rct data laparoscopicassisted vaginal hysterectomy lh tlh singleport laparoscopic hysterectomy rh either abandoned evaluated since lack evidence benefit conventional lh overall evidence review interpreted caution adverse event rates low resulting low power comparisons surgical approach hysterectomy discussed decided light relative benefits hazards benefits hazards seem dependent surgical expertise may influence decision conclusion vh feasible lh may avoid need ah lh associated urinary tract injuries evidence rh benefit population preferably surgical approach hysterectomy decided woman discussion surgeon