***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: STUDY OBJECTIVE To compare operative outcomes and postoperative pain of  laparoscopic hysterectomy ( LH ) versus minilaparoscopic hysterectomy ( MLH ) .  DESIGN R and omized controlled trial ( Canadian Task Force Classification I ) . SETTING Tertiary care center . PATIENTS Seventy-six women scheduled to undergo a hysterectomy for a supposed benign gynecologic condition . INTERVENTIONS Participants were r and omly assigned to LH ( n = 38 ) or MLH  ( n = 38 ) . MLH was performed with use of 3-mm ports . Both patients and assessors of the postoperative outcomes were blinded to the size of port used , and patients ' wounds were concealed by st and ard-size nontransparent dressings . MEASUREMENTS Primary outcome was postoperative pain ( both rest and incident on coughing and abdominal pain , as well as shoulder pain ) by use of a 100-mm visual analogue scale . MAIN RESULTS The two groups were similar in terms of operative outcomes . No intraoperative conversion from MLH to both LH and open surgery occurred . No significant difference in pain scores at 1 , 3 , 8 , and 24 hours after surgery between groups was found . Rescue analgesic requirement was similar in the MLH and LH groups ( 21.1 % vs 13.2 % , p = .54 ) . CONCLUSIONS Ports can safely be reduced in size without a negative impact on the surgeon 's ability to perform LH . MLH appears to have no advantage over LH in terms of postoperative pain Objectives To study the outcome of various  hysterectomies in 2 years 1996 ( N = 10110 ) and 2006 ( N=5279 ) . The hypothesis was that the change in operative practice s in 10 years has result ed in improvements . Design 2 prospect i ve nationwide cohort evaluations with the same question naire . Setting All national operative hospitals in Finl and . Participants Patients scheduled to either abdominal hysterectomy ( AH ) , vaginal hysterectomy ( VH ) or laparoscopic hysterectomy ( LH ) for benign disease . Outcome measures Patients ’ characteristics , surgery-related details and complications ( organ injury , infection , venous thromboembolism and haemorrhage ) . Results The overall complication rates fell in LH and markedly in VH ( from 22.2 % to 11.7 % , p<0.001 ) . The overall surgery-related infectious morbidity decreased in all groups and significantly in VH ( from 12.3 % to 5.2 % , p<0.001 ) and AH ( from 9.9 % to 7.7 % , p<0.05 ) . The incidence of bowel lesions in VH sank from 0.5 % to 0.1 % and of ureter lesions in LH from 1.1 % to 0.3 % . In 2006 there were no deaths compared with three in 1996 . Conclusions The rate of postoperative complications fell markedly in the decade from 1996 to 2006 . This parallels with the recommendation of the recent meta-analyses by Cochrane collaboration ; the order of preference of hysterectomies was for the first time precisely followed in this nationwide study . Trial registration The 2006 study was registered in the Clinical Trials of Protocol Registration System Data ( NCT00744172 ) 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 AIM The aim of the study was to compare the effects of total laparoscopic hysterectomy with those of vaginal hysterectomy . METHODS We conducted a prospect i ve r and omised trial on 400 patients who agreed to be r and omized to either laparoscopic total hysterectomy or vaginal hysterectomy .  They were monitored for one year to evaluate the rate of major complications and the results on quality of life . RESULTS Total laparoscopic hysterectomy was associated with a higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy ( 7 % vs 2.5 % and 2.5 % vs 0 % ; P<0.05 ) only during the first year of study according to a normal learning-curve . It took longer to perform ( 85.9 min vs 46.6 min ) , but was less painful ( visual analogue scale 5.3 vs 6.0 ; P<0.01 ) and there was a shorter stay in hospital after the operation ( 2.9 vs 3.3 days ) . Six weeks after the operation , total laparoscopic hysterectomy was associated with less pain and better quality of life than vaginal hysterectomy ( SF-12 ) . CONCLUSION Total laparoscopic hysterectomy was associated with a significantly higher rate of major haemorrhages and ureteric injuries than vaginal hysterectomy only during the first year of study according to a normal learning-curve . It took longer to perform but was associated with less pain , quicker recovery , and better short term quality of life Objective We design ed this study to focus on women with mobile uteri benign no larger than 14 weeks , who would ordinarily be considered c and i date s for vaginal hysterectomy and compare the outcomes when abdominal routes were chosen . We also compared the intra and post operative complications , requirement for blood transfusion , length of hospital stay , between abdominal and vaginal route of hysterectomy . Method In a simple r and omized prospect i ve comparative study 200 consecutive patients requiring hysterectomy for benign uterine conditions were analysed over a period of 2 years . ( June 2006–May 2008 ) . Group A ( n = 100 ) underwent vaginal hysterectomy ( non descent vaginal hysterectomy , NDVH )  which was compared with group B ( n = 100 ) who had abdominal hysterectomy .  Results As far as duration of operation , duration of i.v . drip , mobilization in post operative ward , duration of hospital stay , P value was significant . Regarding blood loss P value was insignificant . Conclusion The accessibility of the vaginal passage , disease confined to the uterus and the surgeons experience are the major determining factors for the choice of the route of hysterectomy OBJECTIVE : To compare transumbilical single-port laparoscopic hysterectomy ( TSPLH ) with traditional four-port total laparoscopic hysterectomy ( TLH ) . METHODS : Patients with benign uterine disease were assigned to receive either TSPLH  ( n = 52 ) or TLH  ( n = 56 ) . Duration of surgery , intraoperative blood loss , conversion rate , time to first flatus , duration of immobilization , post-operative analgesia requirement , port site infection , port hernia , duration of hospital stay , postoperative fever rate and percentage patient satisfaction were recorded . RESULTS : TSPLH and TLH were both performed successfully . TSPLH was associated with significantly longer duration of surgery , shorter duration of immobilization , lower rate of port site infection and higher patient satisfaction than TLH . There were no other significant differences between the two groups . All subjects recovered fully and no postoperative complications occurred during a 6-month ( minimum ) follow-up period . CONCLUSIONS : TSPLH was found to be a feasible and safe approach for laparoscopic hysterectomy OBJECTIVE To determine whether injecting the colpotomy wound with diluted vasopressin decreases  vaginal bleeding after laparoscopically assisted vaginal hysterectomy ( LAVH ) . METHODS In this prospect i ve controlled study 100 patients who underwent LAVH from July 1 , 2005 to June 30 , 2007 , were r and omized to receive an injection of vasopressin ( n=50 ) or normal saline ( n=50 ) solution in the colpotomy wound . RESULTS In the vasopressin group , bleeding from the colpotomy wound occurred for more than 7 days in 9 patients ( 18 % ) , and none was bleeding after 1 month ; in the control group , the corresponding values were 29 ( 58 % ) and 2 ( 4 % ) . Compared with the study group , the control group had a significantly higher rate of chronic bleeding from the colpotomy wound for more than 7 days and for more than 14 days after LAVH ( P<0.001 for both ) . CONCLUSION Infiltrating the colpotomy wound with diluted vasopressin was found to prevent chronic vaginal bleeding , which frequently occurs following LAVH 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 STUDY OBJECTIVE To compare perioperative outcomes and postoperative pain of  minilaparoscopic ( M-LPS ) and laparoendoscopic single-site total hysterectomy ( LESS ) .  DESIGN Prospect ively r and omized study ( Canadian Task Force classification II-2 ) . SETTING Department of Obstetrics and Gynecology , Division of Gynecologic Oncology , Catholic University of the Sacred Heart , Rome . PATIENTS A total of 86 patients underwent total hysterectomy . Seventy-one met the inclusion criteria and were included in this study . Three of them refused r and omization , 34 were r and omly assigned to undergo to single-port hysterectomy and 34 to undergo to minilaparoscopy . INTERVENTIONS The operative technique is the same in the 2 groups with the exception of videolaparoscopy , port type , and some specific instruments . All surgical procedures were performed with an intrauterine manipulator . Single-port hysterectomy was performed through a multichannel single trocar inserted in the umbilicus . Minilaparoscopic hysterectomy was performed through one optical transumbilical 5-mm trocar and three 3-mm suprapubic ancillary ports . MEASUREMENTS AND MAIN RESULTS Sixty-eight patients met the inclusion criteria and were enrolled in the study . The baseline characteristics of the 2 groups were comparable . Median operative time was longer in LESS with respect to M-LPS ( 120 minutes vs 90 minutes ; p = .038 ) . There were no differences between the 2 groups for median estimated blood loss , ileus , and postoperative stay . Additional 5-mm port insertion was needed in 1 case ( 2.9 % ) in the M-LPS group and in 2 cases ( 5.9 % ) in the LESS group , respectively ( p = .311 ) . No patient had development of intraoperative or early postoperative complications . Patients in the M-LPS group experienced a minor pain at each evaluation , compared with patients who underwent LESS . The rescue analgesic requirement was similar in the 2 groups . CONCLUSIONS Lap 
    Output:
    
There was no evidence of a difference between the groups for the other primary outcomes .
Among women undergoing hysterectomy for benign disease , VH appears to be superior to LH and AH , as it is associated with faster return to normal activities .
Where VH is not possible , LH has some advantages over AH ( including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections ) , but these are offset by a longer operating time .
No advantages of LH over VH could be found ; LH had a longer operation time , and total laparoscopic hysterectomy ( TLH ) had more urinary tract injuries .
Of the three subcategories of LH , there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH .
Single-port laparoscopic hysterectomy and RH should either be ab and oned or further evaluated since there is a lack of evidence of any benefit over conventional LH .
These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision .
In conclusion , when VH is not feasible , LH may avoid the need for AH , but LH is associated with more urinary tract injuries .
There is no evidence that RH is of benefit in this population .