***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The objective of this study was to assess the techniques by which  hysterectomies  are carried out and to determine the rate of total laparoscopic hysterectomy ( TLH ) .  A transversal multicentre study was conducted in 23 gynaecology and obstetrics departments of French University Hospital Centres . The study population comprised only those patients for whom hysterectomy was indicated for benign disease without genital prolapse or urinary stress incontinence . Whereas the rates of performance of hysterectomy by laparotomy and by the vaginal route are comparable [ respectively 40.0 % ( 94 patients ) and 46.8 % ( 110 patients ) ] , the rate of performance of TLH is only 13.2 % ( 31 patients ) . All 23 centres ( 100 % ) carried out hysterectomy by laparotomy and 21 centres ( 91.3 % ) carried out vaginal hysterectomy ; however , only nine centres ( 39.1 % ) carried out TLH . Only seven centres ( 30.4 % ) performed all three types of operation . Of the eight centres whose rate of vaginal hysterectomy was > 60 % , six ( 75 % ) did not carry out TLH .  The study suggests that the usage of the TLH technique appears to be limited . The extent of surgical training is a major factor in the choice of technique for hysterectomy OBJECTIVE To compare peroperative parameters of two variants of a laparovaginal hysterectomy in surgical management of gynecological conditions . METHODS A prospect i ve r and omized study of 70 laparovaginal hysterectomies performed by the same two surgeons for disease of female pelvic organs . The following criteria were studied : indication for surgery , previous surgery , duration of the procedure , recovery , hospital stay , blood loss , tissue damage markers , hysterectomy proportions and complication incidence . Statistical analysis was performed using the non-parametric chi(2)-test and non-parametric Fischer 's exact probability test when appropriate , with a level of significance P=0.05 . RESULTS Totals of 38 ( 54.3 % ) laparoscopy-assisted vaginal and 31 ( 45.7 % ) vaginally assisted laparoscopic hysterectomies were performed for fibroma as the main indication . Conversion to laparotomy was applied in only one patient . The VALH group ( P=0.01 ) showed both fewer procedures and shorter hospital stay with insignificant blood loss . CONCLUSION The two variants of a laparovaginal hysterectomy appear to be safe and appropriate , effective procedures for women with gynecological conditions . Furthermore , vaginally assisted laparoscopic hysterectomy has been shown to be superior to laparoscopy-assisted vaginal hysterectomy in terms of shorter operating time and greater palliative effect upon the complex of uterosacral ligaments . Laparoscopic surgery can alter the relationship between vaginal and abdominal hysterectomy Objective To compare laparoscopically assisted vaginal hysterectomy ( LAVH ) and total abdominal hysterectomy ( TAH ) in patients with uterine fibroids Objective To identify differences in the peri‐operative outcome of women undergoing hysterectomy with bilateral salpingo‐oophorectomy performed either by abdominal hysterectomy and bilateral salpingo‐oophorectomy or by laparoscopic‐assisted salpingo‐oophorectomy and vaginal hysterectomy .  To identify any potential management implication s , including financial differences , between these two forms of operations Objective To compare the effects of laparoscopic hysterectomy and abdominal hysterectomy in the abdominal trial , and laparoscopic hysterectomy and vaginal hysterectomy in the vaginal trial . Design Two parallel , multicentre , r and omised trials . Setting 28 UK centres and two South African centres . Participants 1380 women were recruited ; 1346 had surgery ; 937 were followed up at one year . Primary outcome Rate of major complications . Results In the abdominal trial laparoscopic hysterectomy was associated with a higher rate of major complications than abdominal hysterectomy ( 11.1 % v 6.2 % , P = 0.02 ; difference 4.9 % , 95 % confidence interval 0.9 % to 9.1 % ) and the number needed to treat to harm was 20 . Laparoscopic hysterectomy also took longer to perform ( 84 minutes v 50 minutes ) but was less painful ( visual analogue scale 3.51 v 3.88 , P = 0.01 ) and result ed in a shorter stay in hospital after the operation ( 3 days v 4 days ) . Six weeks after the operation , laparoscopic hysterectomy was associated with less pain and better quality of life than abdominal hysterectomy  ( SF-12 , body image scale , and sexual activity question naires ) . In the vaginal trial we found no evidence of a difference in major complication rates between laparoscopic hysterectomy and vaginal hysterectomy ( 9.8 % v 9.5 % , P = 0.92 ; difference 0.3 % , -5.2 % to 5.8 % ) , and the number needed to treat to harm was 333 . We found no evidence of other differences between laparoscopic hysterectomy and vaginal hysterectomy except that laparoscopic hysterectomy took longer to perform ( 72 minutes v 39 minutes ) and was associated with a higher rate of detecting unexpected pathology ( 16.4 % v 4.8 % , P = < 0.01 ) . However , this trial was underpowered . Conclusions Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy . It also took longer to perform but was associated with less pain , quicker recovery , and better short term quality of life . The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications ; however , vaginal hysterectomy took less time Objective . The present study is a prospect i ve r and omized comparison of laparoscopically assisted vaginal hysterectomy ( LH ) with total abdominal hysterectomy ( TAH ) . OBJECTIVE We compared operative time , length of hospital stay , postoperative recovery , return to work , and costs for women undergoing laparoscopically assisted vaginal hysterectomy or abdominal hysterectomy .  STUDY DESIGN A prospect i ve r and omized clinical trial of  laparoscopically assisted vaginal hysterectomy ( n = 24 ) versus abdominal hysterectomy ( n = 24 ) was carried out in a tertiary care setting . The main outcome variables were operative time , length of hospital stay , and return to work . Secondary outcomes were postoperative pain and return to normal activity as determined by weekly visual analog scales and daily diary . Hospital costs were calculated . RESULTS The laparoscopically assisted vaginal hysterectomy group had longer operative times ( median and quartiles , laparoscopically assisted vaginal hysterectomy 180 [ 139 , 225 ] minutes vs abdominal hysterectomy 130 [ 97 , 155 ] minutes ) , lower requirements for postoperative intravenous analgesia ( patient-controlled analgesia pump , median and quartiles : laparoscopically assisted vaginal hysterectomy 22.1 [ 15.9 , 23.5 ] hours , abdominal hysterectomy 36.7 [ 26.2 , 45.0 ] hours ) , shorter length of hospital stay ( median and quartiles , laparoscopically assisted vaginal hysterectomy 1.5 [ 1.0 , 2.3 ] days , abdominal hysterectomy 2.5 [ 1.5 , 2.5 ] days ) , and quicker return to work ( Kaplan-Meier analysis , P = .03 ) . Both procedures had similar hospital costs ( P = .21 ) . CONCLUSION Laparoscopically assisted vaginal hysterectomy appears to allow patients a more rapid postoperative recovery and an earlier return to work with hospital costs similar to those of abdominal hysterectomy OBJECTIVE We evaluated the advantages and disadvantages of  laparoscopic hysterectomy  over a 2-year period when this new technique was introduced to several hospitals in Finl and . STUDY DESIGN A nationwide register was founded and a prospect i ve multicenter survey of 1165 laparoscopic hysterectomies was carried out from January 1993 to December 1994 . The operations were performed because of uterine fibroids ( 54 % ) , menorrhagia ( 27 % ) , dysmenorrhea ( 8 % ) , endometriosis ( 2 % ) , and other reasons ( 9 % ) by 68 gynecologists at 30 hospitals . RESULTS The mean operation time was 132 minutes . The patients stayed in hospital for an average of 3.3 days , and the mean convalescence period was 17.9 days , half that after abdominal hysterectomy . Complications occurred in 10.2 % of the procedures : infections in 5.6 % , vascular complications in 1.2 % , urinary tract complications in 2.7 % , and bowel complications in 0.4 % . CONCLUSIONS Laparoscopic hysterectomy offers a short hospital stay and convalescence time to the patient , but effective teaching is imperative to minimize , in particular , the risk of urinary tract injuries BACKGROUND To evaluate clinical outcome and tissue trauma after  laparoscopic and abdominal hysterectomy .  METHODS Fifty women scheduled for abdominal hysterectomy were r and omized to undergo either laparoscopic ( n = 25 ) or abdominal ( n = 25 ) hysterectomy .  Surgical characteristics , hospital stay , convalescence and complications were analyzed . Blood sample s for assay of markers of tissue trauma ( interleukin-6 , C-reactive protein , tumor-associated trypsin inhibitor and tumor-associated antigen CA 125 ) were taken preoperatively , on the first , second and seventh postoperative day and at the follow-up visit four weeks after surgery . RESULTS In uncomplicated hysterectomies ( n = 18 ) the operating time ( 85.3 min versus 57.5 min , p < 0.00001 ) was longer for laparoscopic group but the hospital stay ( 2.1 days versus 3.4 days , p < 0.00001 ) and sick leave ( 21.4 days versus 38.5 days , p < 0.00001 ) were shorter in the laparoscopic group . Postoperative increases in all markers were significant in both groups . The interleukin-6 concentration was highest on the first postoperative day in both groups , that of C-reactive protein on the second postoperative day in both groups , tumor-associated trypsin inhibitor on the seventh postoperative day in the laparoscopic group and on the second postoperative day in the abdominal group and tumor-associated antigen CA 125 on the seventh postoperative day in both groups . Both interleukin-6 and C-reactive protein levels were lower in the laparoscopic group on the first ( p = 0.01 and p = 0.03 , respectively ) and on the second postoperative day ( p = 0.02 and p < 0.001 , respectively ) compared with the abdominal group . No differences were seen in tumor-associated trypsin inhibitor and tumor-associated antigen CA 125 levels between the groups . CONCLUSION Laparoscopic hysterectomy should replace abdominal hysterectomy whenever possible because of a more favorable clinical outcome and less tissue trauma Background . To determine under controlled conditions whether there are significant differences in the duration of hospitalization and recovery between abdominal and vaginal hysterectomy for indications other than uterovaginal prolapse The objective of this study was to compare the results of a modified laparoscopically assisted vaginal hysterectomy ( LAVH ) procedure , using light-endorsed transvaginal section by two puncture trocars , with those of total abdominal hysterectomy ( TAH ) in a prospect i ve , r and omized , short-term study . A new , modified LAVH technique using Endo GIA stapler and two puncture trocars was established . For the laparoscopic phase , each adnexum was dissected , and the vesicouterine junction was identified clearly with the laparoscopic light from the vaginal side . Vaginal-phase surgery was performed as usual . Two hundred patients scheduled for abdominal hysterectomy were r and omized to either LAVH ( n = 100 ) or TAH ( n = 100  ) . Duration of hospitalization , time of surgery , dose of analgesics , and rates of complications were significantly lower in the LAVH group ( p < 0.001 ) . The average operating time was 77 ± 30 min for LAVH and 102 ± 18 min for TAH . The duration of hospitalization was 3.2 ± 0.7 days for LAVH and 5.5 ± 1.3 days for TAH . There were three complications in the LAVH group and 15 in the TAH  group . Postoperative meperidine requirements ( 1.2 
    Output:
    
Significantly speedier return to normal activities and other improved secondary outcomes ( shorter duration of hospital stay and fewer unspecified infections or febrile episodes ) suggest that vaginal hysterectomy is preferable to abdominal hysterectomy where possible .
Where vaginal hysterectomy is not possible , laparoscopic hysterectomy is preferable to abdominal hysterectomy , although it brings a higher chance of bladder or ureter injury