| Abstract [eng] |
Hysterectomy is one of the most common surgeries in gynaecology, during which the patient‘s uterus is removed. Recently, modern hysterectomy techniques, including robotic and vaginal natural orifice transluminal endoscopic surgery (VNOTES), have been introduced alongside traditional methods, such as open, vaginal and laparoscopic hysterectomies. Therefore, it is important to compare these methods and evaluate their reliability in gynaecological practice. Aim of the study. To conduct a literature review comparing perioperative and postoperative outcomes of open, vaginal, laparoscopic, robotic and VNOTES hysterectomy. Objectives: 1. To compare perioperative outcomes of different hysterectomy methods; 2. To evaluate postoperative outcomes of different hysterectomy methods; 3. To compare the results of different hysterectomy methods in the treatment of oncologic uterine pathology. Methods. A narrative review was conducted. A literature search was conducted using the scientific literature database PubMed for studies published between 2020 and 2025, using Medical Subject Headings (MeSH). The analysis included preoperative patient characteristics, perioperative and postoperative outcomes of different hysterectomy methods used to treat benign and malignant uterine pathologies. Results. A total of 23 publications were included in this literature review, comprising 5929 patients. The average patient age ranged from 50 to 70 years. The most common benign indication for surgery was abnormal uterine bleeding, while the most common malignancy was cervical cancer. The longest average operative time was observed in robotic hysterectomy (102 min), whereas VNOTES demonstrated the shortest operative time (90 min). Surgical procedures generally lasted longer when treating uterine malignacies (213-255 min). The highest intraoperative blood loss, complication rates and longest hospital stays were associated with open hysterectomy. The lowest rate of postoperative complications (up to 6%) was observed following minimally invasive procedures, including laparoscopic, robotic and VNOTES hysterectomy. Patients who underwent VNOTES hysterectomy reported the best postoperative quality of life. The main disadvantage of robotic and VNOTES hysterectomy was their higher cost compared to traditional techniques. When comparing surgical methods for the treatment of uterine malignancies, the rate of complete tumor resection (R0) and survival was similar between open and minimally invasive (laparoscopic or robotic) hysterectomy. Vaginal and VNOTES hysterectomy were not included in studies assessing malignant uterine pathologies. Conclusion. Minimally invasive surgeries, including laparoscopic, robotic and VNOTES hysterectomy, are associated with lower postoperative complication rate and a more favorable postoperative recovery compared to open surgery. In the treatment of uterine malignancies, laparoscopic and robotic hysterectomy demonstrate clinical outcomes comparable to those of open surgery. |
