Comparative Analysis of Vaginal and Abdominal Uterine Manipulation in Laparoscopic Hysterectomy: The Boztosun Technique

Background/Objectives: Laparoscopic hysterectomy is commonly performed for benign gynecologic conditions, and the choice of uterine manipulation technique may influence surgical outcomes. The Boztosun technique, a modification of the classical Rein technique, enables intra-abdominal manipulation of the uterus without requiring transvaginal instruments. This study aimed to compare the Boztosun technique with a conventional vaginal uterine manipulator in terms of surgical efficiency and perioperative outcomes. Methods: This retrospective study included 30 patients who underwent laparoscopic hysterectomy for benign indications at Akdeniz University Hospital between March 2022 and March 2024. Fifteen patients underwent surgery using the Boztosun technique, and fifteen with a vaginal uterine manipulator. Operative time, colpotomy time, manipulator placement time, hospital stay, uterine weight, hemoglobin change, and complications were compared. Results: The Boztosun technique was associated with significantly shorter operative time (81.67 ± 11.02 min vs. 109 ± 10.85 min, p < 0.001), colpotomy time (4.13 ± 0.92 min vs. 8.87 ± 0.92 min, p < 0.001), manipulator placement time (0.81 ± 0.27 min vs. 8.07 ± 1.22 min, p < 0.001), and hospital stay (2.13 ± 0.35 days vs. 3.53 ± 0.92 days, p < 0.001). No significant differences were found in uterine weight, hemoglobin decrease, or complication rates. All procedures were completed laparoscopically without conversion to open surgery. Conclusions: The Boztosun technique may serve as a safe, efficient, and cost-effective alternative to vaginal uterine manipulators in laparoscopic hysterectomy. Its simplified intra-abdominal approach offers advantages in surgical workflow and recovery. Further prospective studies are needed to validate these findings and assess their applicability in broader clinical settings.