Efficacy of Uterine Manipulator in Total Abdominal Hysterectomy: A Triple-Blinded Randomized Controlled Trial.

Abstract

BackgroundThe objective of this study was to investigate whether the advantages of uterine manipulators in laparoscopic hysterectomy could also be applied to abdominal hysterectomy. In the present study, we introduce a novel surgical technique that employs a uterine manipulator during open surgery and analyze the outcomes of this approach.MethodsA prospective, single-center, randomized controlled trial was conducted at a tertiary research hospital with patients who underwent hysterectomy for benign gynecological indications between October 2023 and March 2024. Patients were randomly assigned to either conventional abdominal hysterectomy or manipulator-assisted abdominal hysterectomy. Primary outcomes included operative time, with secondary outcomes including Visual Analog Scale (VAS) pain scores, intraoperative and postoperative complications, and length of hospital stay.ResultsAmong the 142 participants, the manipulator group exhibited a mean operative time of 92.2 ± 11.1 minutes compared to 107.6 ± 14.4 minutes in the control group (P < .001). Length of hospital stay was also significantly shorter in the manipulator group (42.3 ± 14.7 hours vs 47.4 ± 15.8 hours; P = .046). No significant differences were observed in postoperative complications or pain scores between groups. The mean postoperative hemoglobin decrease was significantly lower in the manipulator group (0.74 ± 0.28 g/dL) compared to the control group (1.52 ± 0.33 g/dL) (P < .001).ConclusionThe incorporation of a uterine manipulator in abdominal hysterectomy significantly reduces operative time, colpotomy time, and hospital stay while maintaining a comparable safety profile to conventional techniques. These findings suggest that uterine manipulators may enhance surgical efficiency and could be beneficial in clinical practice.