Comparison of Single-Site to Multi-Port Laparoscopic Hysterectomy in Patients with Benign or Malignant Gynecological Diseases: A Meta-Analysis of 3,309 Patients
Description
We developed a meta-analysis that was conducted to compare the outcomes between single site laparoscopic hysterectomy and multiport laparasocopic hysterectomy in patients with benign and malignant gynecological diseases. The inclusion criteria were: (1) Patients underwent a total hysterectomy by the SS-LH or MP-LH technique due to benign and malignant gynecological disorders. (2) Papers written in English. (3) Cohort & RCT studies. (4) The study has at least one outcome: complications, blood loss, operative time, length of stay, uterus weight, conversion rate, postoperative pain, port site infection or port site hernia. Our exclusion criteria were: (1) Publications not written in English, (2) studies evaluating vaginal hysterectomies or laparoscopic vaginal-assisted hysterectomy, (3) Case-control studies, cross-sectional studies, systematic reviews, meta-analyses, case reports, case series, basic science research, conference abstracts and review articles. We searched on PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase. We implemented terms and keywords to search for hysterectomy, single-site, single port, single person, surgical wound, incision, and laparoscopy. We identified 716 articles, of which 135 were removed due to duplication, and 559 were excluded for failing to meet the inclusion criteria. 22 studies were include in meta analysis. The information included baseline characteristics and outcomes (Operative time, blood loss, postoperative pain, and overall complications, including intraoperative or postoperative incidents). For continuous outcomes, the sample size, mean and standard deviation (SD) were calculated. When studies reported median rather than mean and range rather than SD, the mean and SD were estimated. For dichotomous outcomes, the total number and the event number of patients in each group in each group were required. Review Manager version 5.3.5 (Cochrane Collaboration, Oxford, UK) was used for statistical analysis. Continuous outcomes were assessed using weighted mean difference (WMD), while dichotomous outcomes were analyzed using risk ratios (RR). All findings were presented with 95% confidence intervals (CI). Statistical heterogeneity, indicating variations in intervention effects across studies due to clinical or methodological differences, was evaluated using the Chi-square test and the I2 test. Substantial heterogeneity was defined as a P value < .10 or I2 > 50%)8. A random-effects model was used to compute the pooled effect to account for variability amongst studies. Forest plots were employed as a visual representation of the results. The analysis included 3,309 patients. SS-LH was associated with fewer complications (RR=0.46, 95% CI=[0.30-0.71], p= 0.0005) and operative time (MD= 13.70 minutes, 95% CI= [2.57-24.83], p= 0.02). Any other significant outcomes were found.
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Review Manager version 5.3.5 (Cochrane Collaboration, Oxford, UK) was used for statistical analysis. Continuous outcomes were assessed using weighted mean difference (WMD), while dichotomous outcomes were analyzed using risk ratios (RR). All findings were presented with 95% confidence intervals (CI). Statistical heterogeneity, indicating variations in intervention effects across studies due to clinical or methodological differences, was evaluated using the Chi-square test and the I2 test. Substantial heterogeneity was defined as a P value < .10 or I2 > 50%)8. A random-effects model was used to compute the pooled effect to account for variability amongst studies. Forest plots were employed as a visual representation of the results.