Hwang Jong Ha, Kim Bitnarae
Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon.
Department of Obstetrics and Gynecology, Dongwon Cancer Specialized Care Hospital, Republic of Korea.
Int J Surg. 2024 Nov 1;110(11):7331-7340. doi: 10.1097/JS9.0000000000001980.
Minimally invasive radical hysterectomy (MIRH) has been increasingly adopted for its benefits of reduced blood loss and shorter hospital stays. This study aims to conduct a meta-analysis to compare the incidence of intraoperative urologic complications, including bladder and ureteral injuries, between MIRH and abdominal radical hysterectomy (ARH).
The authors systematically searched PubMed, EMBASE, and the Cochrane Library for studies published up to April 2024. A total of 35 studies were analyzed to compute odds ratios (ORs) for intraoperative urologic complications, bladder injuries, and ureteral injuries, focusing on subgroup evaluations by publication year, study quality, BMI, geographic region, and surgical method.
The meta-analysis demonstrates that MIRH is associated with higher risks of intraoperative urologic complications (OR=2.412, 95% CI: 1.995-2.916, P <0.001), bladder injuries (OR=2.109, 95% CI: 1.567-2.839, P <0.01), and ureteral injuries (OR=2.549, 95% CI: 1.992-3.262, P <0.001). No publication bias was detected across the studies, ensuring the robustness of the findings. Significant differences in complication rates were also observed across geographic and procedural subgroups.
The findings confirm that MIRH has a higher rate of intraoperative urologic complications, including bladder and ureteral injuries, compared to ARH. These results provide essential insights that could guide clinical decision-making and influence surgical practice guidelines.
微创根治性子宫切除术（MIRH）因其具有减少失血和缩短住院时间的优点而越来越多地被采用。本研究旨在进行一项荟萃分析，以比较MIRH与腹式根治性子宫切除术（ARH）术中泌尿系统并发症（包括膀胱和输尿管损伤）的发生率。
作者系统检索了截至2024年4月发表在PubMed、EMBASE和Cochrane图书馆的研究。共分析了35项研究，以计算术中泌尿系统并发症、膀胱损伤和输尿管损伤的比值比（OR），重点按发表年份、研究质量、体重指数、地理区域和手术方法进行亚组评估。
荟萃分析表明，MIRH与术中泌尿系统并发症（OR=2.412，95%CI：1.995-2.916，P<0.001）、膀胱损伤（OR=2.109，95%CI：1.567-2.839，P<0.01）和输尿管损伤（OR=2.549，95%CI：1.992-3.262，P<0.001）的风险较高相关。在各项研究中未检测到发表偏倚，确保了研究结果的稳健性。在地理和手术亚组中也观察到并发症发生率的显著差异。
研究结果证实，与ARH相比，MIRH术中泌尿系统并发症（包括膀胱和输尿管损伤）的发生率更高。这些结果提供了重要的见解，可指导临床决策并影响手术实践指南。
