Use of Uterine Manipulators in Total Abdominal Hysterectomy: A Systematic Review and Meta-Analysis.

OBJECTIVE

Total abdominal hysterectomy (TAH) remains one of the most frequently performed gynecologic surgeries for benign uterine conditions. Adequate uterine mobilization and surgical exposure are crucial for ensuring procedural safety and efficiency. Uterine manipulators (UM), commonly used in laparoscopic hysterectomy, have been shown to facilitate uterine handling and improve surgical visualization. However, their potential benefits in TAH remain uncertain. The objective of this study was to investigate whether the advantages demonstrated with uterine manipulators in laparoscopic hysterectomy could also be applied to abdominal hysterectomy.

DATA SOURCES: Electronic databases including PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched from inception through September 2025.

METHODS OF STUDY SELECTION: Randomized controlled trials (RCTs) comparing TAH performed with versus without a uterine manipulator were included. Data extraction and quality assessment were performed independently by 2 reviewers. Meta-analysis was conducted using RevMan software. The primary outcome was operative time, while secondary outcomes included perioperative hemoglobin reduction, postoperative vaginal length, and complication rates.

TABULATION, INTEGRATION, AND

RESULTS

Four randomized controlled trials (RCTs) encompassing 340 participants met the inclusion criteria. Use of a uterine manipulator was associated with a significantly shorter operative time compared with conventional hysterectomy. Hemoglobin reduction was also significantly lower in the manipulator group (p <.001). Additionally, postoperative vaginal length was significantly greater among patients who underwent TAH with a uterine manipulator (p <.001). No significant difference was observed in complication rates between both groups.

CONCLUSION

Uterine manipulator use in TAH reduces operative time, minimizes perioperative blood loss, and helps preserve postoperative vaginal length. However, high risk of bias related to lack of blinding limits the certainty of these findings.