Related Experiment Video
Updated: Feb 21, 2026
Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity
Published on: August 2, 2024
Survival Association of Intrauterine Manipulator Use During Minimally Invasive Hysterectomy for Endometrial Cancer: A
Yoshikazu Nagase1, Shinya Matsuzaki, Hiroshi Yoshida
1Department of Obstetrics and Gynecology, University of Osaka Graduate School of Medicine, the Department of Obstetrics and Gynecology, Kaizuka City Hospital, and the Department of Gynecology, Osaka International Cancer Institute, Osaka, the Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, the Department of Obstetrics and Gynecology, Yamagata University Graduate School of Medicine, Yamagata, and the Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan; the Department of Obstetrics and Gynecology, University Medical Center, University of Freiburg Faculty of Medicine, Freiburg, Germany; the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology and the Norris Comprehensive Cancer Center, University of Southern California, and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Los Angeles General Medical Center, Los Angeles, California; the Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas; and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, New York.
Objective:
To evaluate the association between intrauterine manipulator use and survival outcomes in patients undergoing minimally invasive hysterectomy for endometrial cancer because the oncologic effects of intrauterine manipulator use remain controversial.
Data Sources:
A comprehensive systematic review of the literature published up to December 31, 2024, was conducted with the PubMed, Scopus, Web of Science, and Cochrane Library databases.
Methods Of Study Selection:
Two independent investigators screened comparative studies, including prospective or retrospective studies and randomized controlled trials, examining oncologic outcomes in patients with endometrial cancer who underwent minimally invasive hysterectomy with or without an intrauterine manipulator. Studies with insufficient outcome data, including those involving patients who underwent open abdominal hysterectomy and those published in languages other than English, were excluded.
Tabulation, Integration, And Results:
Data extraction and synthesis were performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Random-effects analysis was used for data pooling. The primary outcomes were disease-free survival and overall survival. Confounding factors affecting prognosis and risk of bias were also evaluated. Between 2013 and 2024, 12 eligible studies, including 10 retrospective studies and two randomized controlled trials, enrolled 6,029 patients who underwent minimally invasive hysterectomy with an intrauterine manipulator and 4,776 patients without one. In the unadjusted pooled analysis, disease-free survival was lower in patients who underwent surgery with an intrauterine manipulator than in those without (nine studies, hazard ratio 1.18, 95% CI, 1.01-1.38, P =.04). Albeit statistically nonsignificant, the hazard ratio for all-cause mortality comparing intrauterine manipulator use with nonuse was 1.27 (six studies, 95% CI, 0.99-1.62, P =.06). Only a limited number of studies (4 of 12 studies, 33.3%) examined survival outcomes after adjustment for factors such as adjuvant treatment and tumor histology. Most studies (7 of 12, 58.3%) had a moderate risk of bias, and five (41.6%) had a serious risk of bias.
Conclusion:
This meta-analysis suggests that intrauterine manipulator use during minimally invasive hysterectomy may be associated with decreased disease-free survival in patients with endometrial cancer; however, the association with overall survival is marginal and did not reach statistical significance. Considering that most studies included in this meta-analysis were retrospective, did not adjust for prognostic factors such as postoperative treatment, and were of low to moderate quality, the associations found in this study warrant further investigation in future prospective trials.
Systematic Review Registration:
PROSPERO, CRD42023428140.
More Related Videos
05:46Introduction of Intracapsular Rotary-cut Procedures IRCP: A Modified Hysteromyomectomy Procedures Facilitating Fertility Preservation
Published on: January 17, 2019
05:21Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025