title: Efficacy and safety of uterine manipulators in laparoscopic surgery: a review.
abstract: OBJECTIVE
  This review aims to objectively assess the efficacy and safety of uterine manipulators as reported in scientific literature. Furthermore, it evaluates as to which manipulator best suits which surgical procedure.
  
  
  METHODS
  PubMed, Embase, Web of Science, COCHRANE, CINAHL, Academic Search Premier, Science Direct and the MAUDE database were searched. Technical information was retrieved from the manufacturers.
  
  
  RESULTS
  25 articles covering 10 uterine manipulators were found. Studies regarding implementation and use of manipulators are scarce; only two surveys were found comparing different manipulators. Moreover, clinical evidence proving the efficacy of manipulators with respect to prevention of complications, inherent to laparoscopic surgery, does not exist.
  
  
  CONCLUSIONS
  The use of uterine manipulators is well established and it is clear that uterine manipulators offer the easiest way to handle the uterus during surgery. However, detailed information regarding efficacy and safety is scarce. Clinical evidence substantiating the assumed mechanism of prevention of ureter injuries was not found. Our review did not find the optimal manipulator. Some are more versatile than others and not all instruments are appropriate for all types of surgery. Therefore, gynecologists should choose the manipulator that best suits the type of surgery that is performed.
authors.affiliation: Department of Gynecology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands. l.van_den_haak@lumc.nl.
authors.forename: L
authors.initials: L
authors.lastname: van den Haak
authors.affiliation: Department of Gynecology, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Alleblas
authors.affiliation: Department of Gynecology, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: T E
authors.initials: TE
authors.lastname: Nieboer
authors.affiliation: Department of Gynecology, Bronovo Hospital, PO Box 96900, 2509 JH, The Hague, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Rhemrev
authors.affiliation: Department of Gynecology, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands. f.w.jansen@lumc.nl.|Department BioMechanical Engineering, Delft University of Technology, PO Box 5, 2600 AA, Delft, The Netherlands. f.w.jansen@lumc.nl.
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
mesh_terms: D004869:Equipment Safety; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation*; D010535:Laparoscopy / Q000379:methods*; D013525:Surgical Instruments; D014599:Uterus
keywords: Hysterectomy; Laparoscopy; Review; Uterine manipulator