Uterine manipulator in total laparoscopic hysterectomy: safety and usefulness

  • Yara Abdel Khalek
  • Roger Bitar
  • Costas Christoforou
  • Simone Garzon
  • Alessandro Tropea
  • Antonio Biondi
  • Zaki SleimanEmail author
Original Article


The aim of this review is to evaluate the effectiveness and safety of uterine manipulators in facilitating total laparoscopic hysterectomy (TLH). A literature search in MEDLINE, EMBASE, Cochrane Library, UpToDate, SpringerLink, ClinicalKey and Elsevier ScienceDirect databases was performed, and articles describing TLH with or without the use of uterine manipulators were retrieved. Complications related to the use of uterine manipulators are numerous, and although uterine manipulator seems to facilitate TLH, the procedure without a uterine manipulator seems to have a comparable safety and effectiveness, although evidence based on a direct comparison of the two approaches is limited without available controlled trials. Uterine manipulator may provide support in cases of large uteri, severe endometriosis, recto vaginal adhesions and regional anesthesia, while its use may increase complications in cases of vaginal stenosis and nulliparity. Therefore, to perform TLH, the surgeon should individualize for each case if uterine manipulator is needed and which manipulator best suits the surgical procedure requirements and case characteristics. Further studies comparing the two approaches are mandatory.


Hysterectomy Laparoscopy Uterine manipulator Surgical Instruments Intraoperative complications 



The work was not supported by any grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

The paper is a review research and does not include any intervention with human participants or animals.

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Italian Society of Surgery (SIC) 2019

Authors and Affiliations

  • Yara Abdel Khalek
    • 1
  • Roger Bitar
    • 2
  • Costas Christoforou
    • 3
  • Simone Garzon
    • 4
  • Alessandro Tropea
    • 5
  • Antonio Biondi
    • 6
  • Zaki Sleiman
    • 1
    • 2
    Email author
  1. 1.Department of Obstetrics and GynecologySaint Joseph UniversityBeirutLebanon
  2. 2.Department of Obstetrics and GynecologyLebanese American UniversityBeirutLebanon
  3. 3.Christoforou ClinicLarnacaCyprus
  4. 4.Department of Obstetrics and Gynecology“Filippo Del Ponte” Hospital, University of InsubriaVareseItaly
  5. 5.Department for the Treatment and Study of Abdominal Diseases and Abdominal TransplantationIRCCS-ISMETT(Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center ItalyPalermoItaly
  6. 6.Department of General Surgery and Medical Surgical SpecialtiesUniversity of CataniaCataniaItaly

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