Intrauterine manipulator during hysterectomy for endometrial cancer: a systematic review and meta-analysis of oncologic outcomes

Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes

“…12 In contrast, a 2023 Italian meta-analysis summariezed the results of nine studies assessing lymphovascular space invasion. 16 In a pooled analysis, the incidences of lymphovascular space invasion were 19.5% versus 13.8% for the intrauterine manipulator and non-manipulator groups, respectively (OR 1.11, 95% CI 0.67 to 1.90). One explanation for these heterogenous findings across past and current investigations may be related to differences in study populations such that distribution of cancer stage and histology type differed among these studies.…”

“…14 More recently, a 2023 meta-analysis of six studies examined the incidence of malignant peritoneal cytology related to intrauterine manipulator use. 16 In a pooled analysis (n=227 for intrauterine manipulator vs n=375 for non-manipulator), the incidences of malignant peritoneal cytology were 9.3% versus 5.3% (OR 1.66, 95% CI 0.67 to 4.16). The CI of the study widened compared with the prior 2022 meta-analysis (low-high range, 3.49 vs 2.12), 15 implying variable findings across the studies.…”

“…5 10 11 One area of active investigation and controversy is the oncologic safety of intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer. [12][13][14][15][16] This surgical device is inserted into the endometrial cavity through the uterine cervix during laparoscopic hysterectomy to facilitate anatomical identification and exposure during surgery. Some surgeons advocate for its use to reduce surgical morbidity, while others voice concerns related to possible iatrogenic tumor spill by insertion of an intrauterine manipulator into the tumor site.…”

“…This variability in opinion has resulted in a heterogenous and wide range of intrauterine manipulator use (20-90%). [15][16][17] Moreover, results of previous investigations examining the effects of intrauterine manipulator use on pathological findings of hysterectomy specimens as well as survival outcomes in endometrial cancer are mixed, [12][13][14][15][16] highlighting the importance and necessity to address this surgical practice. The objective of this study was to examine the association between intrauterine manipulator use and pathological factors and oncologic outcomes in patients with endometrial cancer who underwent laparoscopic hysterectomy in Japan.…”

Type and approach of hysterectomy and oncological survival of women with stage II cancer of endometrium: a large retrospective cohort study

“…In 2018, several authors questioned the safety of minimally invasive surgery for women with cervical cancer through their studies ( 8 , 9 ). They thought the following factors might deteriorate the survival of patients with cervical cancer who underwent minimally invasive surgery: the routine use of a uterine manipulator and the insufflation gas when performing laparoscopy ( 34 , 35 ). However, the findings of their studies are not valid among apparent early-stage endometrial cancer.…”