Vaginal Hysterectomy: A Network-Meta-analysis Comparing Short-Term Outcomes of Surgical Techniques and Devices.

To provide available evidence comparing surgical outcomes of different vaginal hysterectomy (VH) techniques and devices. Pubmed, Embase and ClinicalTrials.gov databases were searched from inception to Dec 1, 2023, using relevant key words. Studies comparing at least two 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. Ten randomized controlled trials and seven observational studies were eligible reporting on 1,577 women undergoing VH with different techniques and devices (50% conventional, 22.5% Ligasure®, 17.3% BiClamp®, and 9.2% natural orifice transluminal endoscopic surgery-vNOTES). All surgical techniques/devices had a comparable risk ratio in terms of intraoperative complications, but Clavien-Dindo Grade III post-operative complications were significantly reduced in the vNOTES group (risk ratio 0.15; 95% CI, 0.03 to 0.82; I Modern surgical techniques/devices have the potential to improve anatomical exposure and to reduce morbidity of VH. This may drive resurgence of vaginal approach to hysterectomy.

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