Is vaginal hysterectomy outdated? A systematic overview of reviews with future perspectives

Background: Hysterectomy is the second most common surgical procedure in women. Vaginal hysterectomy (VH) historically represents the preferred approach for benign conditions due to its minimally invasive nature. However, with advances in endoscopic techniques, the role of VH has been questioned. This review aims to systematically summarize existing evidence coming from currently available systematic reviews and meta-analyses which compare VH with other techniques such as laparotomy, laparoscopy and robotics. Methods: We systematically searched Pubmed, Scopus, EMBASE and Cochrane library from 1st January 1996 to 31st July 2024. We conducted a systematic overview of reviews to compare VH with abdominal, laparoscopic, and robotic hysterectomy, focusing on procedural parameters, complications and patient outcomes. The quality of evidence and certainty of findings were critically assessed. Results: Our findings suggest that VH has shorter operative time compared to all the other approaches. Compared to laparotomy, VH is associated with reduced time from hospital admission to recovery. No differences were found concerning intra- and post-operative complications demonstrating VH as a safe superimposable technique. The quality of the evidence ranged from critical to moderate, with high heterogeneity among the studies, requiring cautious interpretation. Conclusion: VH offers reduced operating times and faster recovery in comparison to alternative techniques, with comparable complication rates. These data support the clinical relevance of VH as a valuable option for benign gynecological conditions. However, a nuanced comparison with alternative and innovative techniques are essential for personalized surgical decisions and a potential renaissance of this approach.