{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T20:04:50Z","timestamp":1770753890882,"version":"3.50.0"},"reference-count":55,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000664","name":"Health Technology Assessment programme","doi-asserted-by":"publisher","award":["NIHR128991"],"award-info":[{"award-number":["NIHR128991"]}],"id":[{"id":"10.13039\/501100000664","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journalslibrary.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["Health Technol Assess"],"abstract":"\n Background<\/jats:title>\n The comparative rates of major complications and recovery times between laparoscopic hysterectomy and abdominal hysterectomy for benign gynaecological conditions remain uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective(s)<\/jats:title>\n To assess the clinical and cost-effectiveness of laparoscopic hysterectomy compared to abdominal hysterectomy in women with benign gynaecological conditions.<\/jats:p>\n <\/jats:sec>\n \n Design and methods<\/jats:title>\n A parallel, open, non-inferiority, multicentre, randomised controlled, expertise-based surgery trial with integrated health economic evaluation and an internal pilot with an embedded qualitative process evaluation, and a post-closure survey after recruitment ended.<\/jats:p>\n <\/jats:sec>\n \n Setting and participants<\/jats:title>\n Women in secondary care requiring hysterectomy and eligible for either surgical method.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Laparoscopic hysterectomy versus abdominal hysterectomy.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n The primary outcome was major complications (Clavien\u2013Dindo\u00a0\u2265\u00a0level III) up to 6 completed weeks post surgery, and the key secondary outcome was time from surgery to resumption of usual activities using the personalised Patient-Reported Outcomes Measurement Information System Physical Function questionnaire. The principal outcome for the economic evaluation was to be cost per quality-adjusted life-year at 12 months post surgery and was feasibility and acceptability for the qualitative process evaluation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Two hundred and fifty-two patients were screened from 13 open sites over 13 months, 156 (62%) were eligible and 75 (49%) randomised. Of the 53 women not randomised, 23 (43%) preferred laparoscopic hysterectomy and 6 (11%) abdominal hysterectomy. About 32\/39 (82%) and 30\/36 (83%) participants randomised to laparoscopic hysterectomy and abdominal hysterectomy, respectively, had their surgery, of which 31\/32 (97%) and 25\/30 (83%) received their allocated route of hysterectomy. Major complications occurred in 2\/32 (6%) laparoscopic hysterectomy versus 4\/30 (13%) abdominal hysterectomy groups. There was no difference in time to resumption of activities [median (interquartile range,\n N<\/jats:italic>\n ) 7.5 weeks (3.6\u20138.2, 25) laparoscopic hysterectomy vs. 7.5 weeks (5.5\u201310.6, 26) abdominal hysterectomy groups] or quality of recovery [mean (standard deviation,\n N<\/jats:italic>\n ) 81.1 (13.4, 27) vs. 72.3 (17.6, 22) respectively; adjusted mean difference 7.2, 95% confidence interval \u22123.2 to 17.6]. The qualitative evaluation found that the trial was viewed positively by women and healthcare professionals. The reasons for failure to recruit from 21 sites open or in set-up were lack of research\/clinical capacity imposed by the COVID-19 pandemic (14, 67%) and lack of clinician equipoise (11, 52%).\n <\/jats:p>\n <\/jats:sec>\n \n Limitations<\/jats:title>\n The main limitation was failure to recruit, resulting in a final sample of 75 patients from a target of 3250. At the time of analysis, 13 (17%) randomised patients had not had surgery, and 6 (8%) did not adhere to the allocated route of hysterectomy. The planned health economic evaluation could not be performed.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The LAVA trial was acceptable for women and healthcare professionals but closed early due to the adverse impact of the COVID-19 pandemic and a lack of clinician equipoise. No significant differences in complications or recovery between laparoscopic hysterectomy and abdominal hysterectomy were observed. However, early trial cessation because of recruitment challenges limit inferences. Future large-scale trials are important, especially as laparoscopic hysterectomy and robotic techniques become standard. Success will depend on innovative trial designs and strategies that engage clinicians and research departments.<\/jats:p>\n <\/jats:sec>\n \n Future work<\/jats:title>\n Lessons learnt from the failed LAVA trial should be used to inform the management and designs of future studies in benign gynaecological surgery.<\/jats:p>\n <\/jats:sec>\n \n Funding<\/jats:title>\n This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR128991.<\/jats:p>\n <\/jats:sec>","DOI":"10.3310\/gjtc1718","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T09:16:13Z","timestamp":1752830173000},"page":"1-27","update-policy":"https:\/\/doi.org\/10.3310\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Laparoscopic hysterectomy versus open abdominal hysterectomy for women with a benign gynaecological condition: the LAVA RCT"],"prefix":"10.3310","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5943-1062","authenticated-orcid":true,"given":"T Justin","family":"Clark","sequence":"first","affiliation":[{"name":"Department of Gynaecology, Birmingham Women\u2019s NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4893-0576","authenticated-orcid":true,"given":"Lina","family":"Antoun","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, Birmingham Women\u2019s NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5119-1431","authenticated-orcid":true,"given":"Rebecca","family":"Woolley","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0389-4412","authenticated-orcid":true,"given":"Sheriden","family":"Bevan","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-9432-8378","authenticated-orcid":true,"given":"Kamila","family":"Ziomek","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8734-2932","authenticated-orcid":true,"given":"William","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1430-5732","authenticated-orcid":true,"given":"Paul","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, Birmingham Women\u2019s NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1486-0071","authenticated-orcid":true,"given":"Kevin","family":"Cooper","sequence":"additional","affiliation":[{"name":"Aberdeen Royal Infirmary, Aberdeen, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-4107","authenticated-orcid":true,"given":"Ertan","family":"Saridogan","sequence":"additional","affiliation":[{"name":"Elizabeth Garrett Anderson Institute for Women\u2019s Health, University College London Hospitals, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5704-6489","authenticated-orcid":true,"given":"Bibi Zeyah","family":"Sairally","sequence":"additional","affiliation":[{"name":"Department of Gynaecology, Birmingham Women\u2019s NHS Foundation Trust, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9437-7356","authenticated-orcid":true,"given":"Jayne","family":"Fullard","sequence":"additional","affiliation":[{"name":"Public and Patient Involvement"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7172-9604","authenticated-orcid":true,"given":"Monique","family":"Morgan","sequence":"additional","affiliation":[{"name":"Public and Patient Involvement"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5760-1080","authenticated-orcid":true,"given":"Lynsay","family":"Matthews","sequence":"additional","affiliation":[{"name":"School of Health and Life Sciences, University of the West of Scotland, South Lanarkshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4018-3855","authenticated-orcid":true,"given":"Laura","family":"Jones","sequence":"additional","affiliation":[{"name":"Institute for Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0624-0537","authenticated-orcid":true,"given":"Tracy","family":"Roberts","sequence":"additional","affiliation":[{"name":"Institute for Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4621-1922","authenticated-orcid":true,"given":"Lee","family":"Middleton","sequence":"additional","affiliation":[{"name":"Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"6221","published-online":{"date-parts":[[2026,2]]},"reference":[{"key":"key2026021020252300_ref1-bib1","doi-asserted-by":"crossref","first-page":"e096265","DOI":"10.1136\/bmjopen-2024-096265","article-title":"Comparison of complications and recovery after laparoscopic and abdominal hysterectomy for benign disease: the LAparoscopic Versus Abdominal hysterectomy (LAVA) randomised controlled trial","volume":"15","author":"Antoun","year":"2025","journal-title":"BMJ Open"},{"key":"key2026021020252300_ref2-bib2","doi-asserted-by":"crossref","first-page":"e070218","DOI":"10.1136\/bmjopen-2022-070218","article-title":"LAparoscopic Versus Abdominal hysterectomy (LAVA): protocol of a randomised controlled trial","volume":"13","author":"Antoun","year":"0218","journal-title":"BMJ Open"},{"key":"key2026021020252300_ref3-bib3","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"8","author":"Pickett","year":"2023","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026021020252300_ref4-bib4","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1136\/bmj.328.7440.643","article-title":"Results of eVALuate study of hysterectomy techniques: high rate of complications needs explanation","volume":"328","author":"Donnez","year":"2004","journal-title":"BMJ"},{"key":"key2026021020252300_ref5-bib5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/s12905-019-0784-4","article-title":"Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review and meta-analysis","volume":"19","author":"Lee","year":"2019","journal-title":"BMC Womens Health"},{"key":"key2026021020252300_ref6-bib6","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/1471-0528.15539","article-title":"Route of hysterectomy: a retrospective, cohort study in English NHS Hospitals from 2011 to 2017","volume":"126","author":"Madhvani","year":"2019","journal-title":"BJOG"},{"key":"key2026021020252300_ref7-bib7","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.2147\/JMDH.S453467","article-title":"Patient experience pre-implementation of an enhanced recovery after surgery protocol: a qualitative investigation","volume":"17","author":"Poletti","year":"2024","journal-title":"J Multidiscip Healthc"},{"key":"key2026021020252300_ref8-bib8","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jclinepi.2017.03.011","article-title":"The Dutch-Flemish PROMIS Physical Function item bank exhibited strong psychometric properties in patients with chronic pain","volume":"87","author":"Crins","year":"2017","journal-title":"J Clin Epidemiol"},{"key":"key2026021020252300_ref9-bib9","first-page":"1733","article-title":"Dutch-Flemish translation of 17 item banks from the patient-reported outcomes measurement information system (PROMIS)","volume":"23","author":"Terwee","year":"2014","journal-title":"Qual Life Res"},{"key":"key2026021020252300_ref10-bib10","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0140-6736(18)31113-9","article-title":"Personalised perioperative care by e-health after intermediate-grade abdominal surgery: a multicentre, single-blind, randomised, placebo-controlled trial","volume":"392","author":"van der Meij","year":"2018","journal-title":"Lancet"},{"key":"key2026021020252300_ref11-bib11","doi-asserted-by":"crossref","first-page":"103","DOI":"10.52054\/FVVO.13.2.024","article-title":"Is there still need for a further randomised controlled trial on the route of hysterectomy for benign disease?","volume":"13","author":"Clark","year":"2021","journal-title":"Facts Views Vis Obgyn"},{"key":"key2026021020252300_ref12-bib12","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"key2026021020252300_ref13-bib13","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1097\/ALN.0b013e318289b84b","article-title":"Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15","volume":"118","author":"Stark","year":"2013","journal-title":"Anesthesiology"},{"key":"key2026021020252300_ref14-bib14","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0168-8510(90)90421-9","article-title":"EuroQol \u2013 a new facility for the measurement of health-related quality of life","volume":"16","author":"EuroQol Group","year":"1990","journal-title":"Health Policy"},{"key":"key2026021020252300_ref15-bib15","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2165\/00019053-199304050-00006","article-title":"The validity and reproducibility of a work productivity and activity impairment instrument","volume":"4","author":"Reilly","year":"1993","journal-title":"PharmacoEconomics"},{"key":"key2026021020252300_ref16-bib16","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1093\/humrep\/16.7.1473","article-title":"Morbidity of 10110 Hysterectomies by type approach","volume":"16","author":"Makinen","year":"2001","journal-title":"Hum Reprod"},{"key":"key2026021020252300_ref17-bib17","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1097\/AOG.0b013e31824b1966","article-title":"Predictors of successful surgical outcome in Laparoscopic hysterectomy","volume":"119","author":"Twijnstra","year":"2012","journal-title":"Obstet Gynecol"},{"key":"key2026021020252300_ref18-bib18","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.jmig.2018.09.775","article-title":"Surgeon volume in benign gynecologic surgery: review of outcomes, impact on training, and ethical contexts","volume":"26","author":"Glaser","year":"2019","journal-title":"J Minim Invasive Gynecol"},{"key":"key2026021020252300_ref19-bib19","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.ajog.2016.02.048","article-title":"Surgical outcomes for low-volume vs high-volume Surgeons in Gynecology surgery: a systematic review and meta-analysis","volume":"215","author":"Mowat","year":"2016","journal-title":"Am J Obstet Gynecol"},{"key":"key2026021020252300_ref20-bib20","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1136\/bmj.37984.623889.F6","article-title":"The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy","volume":"328","author":"Garry","year":"2004","journal-title":"BMJ"},{"key":"key2026021020252300_ref21-bib21","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1002\/(SICI)1097-0258(19991015)18:19<2605::AID-SIM237>3.0.CO;2-N","article-title":"The implications of variation in outcome between health professionals for the design and analysis of randomized controlled trials","volume":"18","author":"Roberts","year":"1999","journal-title":"Stat Med"},{"key":"key2026021020252300_ref22-bib22","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1186\/s13063-015-0739-5","article-title":"A systematic review of the use of an expertise-based randomised controlled trial design","volume":"16","author":"Cook","year":"2015","journal-title":"Trials"},{"key":"key2026021020252300_ref23-bib23","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.jclinepi.2004.08.012","article-title":"Intraclass correlation coefficient and outcome prevalence are associated in clustered binary data","volume":"58","author":"Gulliford","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"key2026021020252300_ref24-bib24","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/1745-6215-12-151","article-title":"Intracluster correlation coefficients and coefficients of variation for perinatal outcomes from five cluster-randomised controlled trials in low and middle-income countries: results and methodological implications","volume":"12","author":"Pagel","year":"2011","journal-title":"Trials"},{"key":"key2026021020252300_ref25-bib25","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1111\/1471-0528.12494","article-title":"Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands","volume":"121","author":"Anema","year":"2014","journal-title":"BJOG"},{"key":"key2026021020252300_ref26-bib26","doi-asserted-by":"crossref","first-page":"2409","DOI":"10.1002\/sim.4274","article-title":"The use of restricted mean survival time to estimate the treatment effect in randomized clinical trials when the proportional hazards assumption is in doubt","volume":"30","author":"Royston","year":"2011","journal-title":"Stat Med"},{"key":"key2026021020252300_ref27-bib27","doi-asserted-by":"crossref","first-page":"35","DOI":"10.52054\/FVVO.16.1.003","article-title":"Lessons learnt from the multi-centre LAparoscopic Versus Abdominal hysterectomy (LAVA) randomised controlled trial","volume":"16","author":"Antoun","year":"2024","journal-title":"Facts Views Vis Obgyn"},{"key":"key2026021020252300_ref28-bib28","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.jclinepi.2014.03.010","article-title":"The intellectual challenges and emotional consequences of equipoise contributed to the fragility of recruitment in six randomized controlled trials","volume":"67","author":"Donovan","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"key2026021020252300_ref29-bib29","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/j.socscimed.2009.02.023","article-title":"It\u2019s not just what you say, it\u2019s also how you say it: opening the \u2018black box\u2019 of informed consent appointments in randomised controlled trials","volume":"68","author":"Wade","year":"2009","journal-title":"Soc Sci Med"},{"key":"key2026021020252300_ref30-bib30","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1097\/OGX.0000000000000259","article-title":"Enhanced recovery pathways in Gynecology and gynecologic oncology","volume":"70","author":"Barber","year":"2015","journal-title":"Obstet Gynecol Surv"},{"key":"key2026021020252300_ref31-bib31","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1002\/ijgo.13280","article-title":"Surgical prioritization of obstetrics and gynecology procedures in the UK during the COVID-19 pandemic","volume":"150","author":"Memon","year":"2020","journal-title":"Int J Gynaecol Obstet"},{"key":"key2026021020252300_ref32-bib32","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/ijgo.12023","article-title":"Systematic review of same-day discharge after minimally invasive hysterectomy","volume":"136","author":"Korsholm","year":"2017","journal-title":"Int J Gynaecol Obstet"},{"key":"key2026021020252300_ref33-bib33","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/1745-6215-10-9","article-title":"The challenges faced in the design, conduct and analysis of surgical randomised controlled trials","volume":"10","author":"Cook","year":"2009","journal-title":"Trials"},{"key":"key2026021020252300_ref34-bib34","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1002\/bjs.1800800807","article-title":"Surgical evaluation at the crossroads","volume":"80","author":"Pollock","year":"1993","journal-title":"Br J Surg"},{"key":"key2026021020252300_ref35-bib35","doi-asserted-by":"crossref","first-page":"1448","DOI":"10.1136\/bmj.324.7351.1448","article-title":"Randomised trials in surgery: problems and possible solutions","volume":"324","author":"McCulloch","year":"2002","journal-title":"BMJ"},{"key":"key2026021020252300_ref36-bib36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1745-6215-14-166","article-title":"A reinvestigation of recruitment to randomised, controlled, multicenter trials: a review of trials funded by two UK funding agencies","volume":"14","author":"Sully","year":"2013","journal-title":"Trials"},{"key":"key2026021020252300_ref37-bib37","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1186\/s13063-021-05403-5","article-title":"The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography","volume":"22","author":"Davies","year":"2021","journal-title":"Trials"},{"key":"key2026021020252300_ref38-bib38","first-page":"MR000045","article-title":"Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis","volume":"10","author":"Houghton","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026021020252300_ref39-bib39","doi-asserted-by":"crossref","first-page":"iii, ix","DOI":"10.3310\/hta11480","article-title":"Recruitment to randomised trials: strategies for trial enrollment and participation study. The STEPS study","volume":"11","author":"Campbell","year":"2007","journal-title":"Health Technol Assess"},{"key":"key2026021020252300_ref40-bib40","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1016\/j.ajog.2010.02.039","article-title":"Racial and ethnic disparities in benign gynecologic conditions and associated surgeries","volume":"202","author":"Jacoby","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"key2026021020252300_ref41-bib41","first-page":"1","article-title":"A randomised controlled trial of Outpatient versus inpatient Polyp Treatment (OPT) for abnormal uterine bleeding","volume":"19","author":"Clark","year":"2015","journal-title":"Health Technol Assess"},{"key":"key2026021020252300_ref42-bib42","first-page":"1","article-title":"Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT","volume":"26","author":"Daniels","year":"2022","journal-title":"Health Technol Assess"},{"key":"key2026021020252300_ref43-bib43","first-page":"1425","article-title":"Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial","volume":"394","author":"Cooper","year":"2019","journal-title":"published correction appears in Lancet"},{"key":"key2026021020252300_ref44-bib44","doi-asserted-by":"crossref","first-page":"e079006","DOI":"10.1136\/bmj-2023-079006","article-title":"Long acting progestogens versus combined oral contraceptive pill for preventing recurrence of endometriosis related pain: the PRE-EMPT pragmatic, parallel group, open label, randomised controlled trial","volume":"385","author":"Cooper","year":"2024","journal-title":"BMJ"},{"key":"key2026021020252300_ref45-bib45","doi-asserted-by":"crossref","first-page":"e002360","DOI":"10.1136\/bmjopen-2012-002360","article-title":"Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis","volume":"3","author":"Treweek","year":"2013","journal-title":"BMJ Open"},{"key":"key2026021020252300_ref46-bib46","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1365-2702.2009.03041.x","article-title":"Clinical trials: the challenge of recruitment and retention of participants","volume":"19","author":"Gul","year":"2010","journal-title":"J Clin Nurs"},{"key":"key2026021020252300_ref47-bib47","first-page":"82","article-title":"Are we missing anything? Pursuing research on attrition","volume":"36","author":"Marcellus","year":"2004","journal-title":"Can J Nurs Res"},{"key":"key2026021020252300_ref48-bib48","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"2015","author":"Aarts","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"key2026021020252300_ref49-bib49","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1186\/s13063-015-0908-6","article-title":"A systematic review of training programmes for recruiters to randomised controlled trials","volume":"16","author":"Townsend","year":"2015","journal-title":"Trials"},{"key":"key2026021020252300_ref50-bib50","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1021\/es504719g","article-title":"Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States","volume":"49","author":"Thiel","year":"2015","journal-title":"Environ Sci Technol"},{"key":"key2026021020252300_ref51-bib51","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1111\/1471-0528.17242","article-title":"Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022)","volume":"130","author":"Nobbenhuis","year":"2023","journal-title":"BJOG"},{"key":"key2026021020252300_ref52-bib52","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1177\/15533506241238038","article-title":"Robot assisted laparoscopic surgery in gynaecology: an evolving assistive technology","volume":"31","author":"Xie","year":"2024","journal-title":"Surg Innov"},{"key":"key2026021020252300_ref53-bib53","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1007\/s11701-023-01724-6","article-title":"Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis","volume":"17","author":"Lenfant","year":"2023","journal-title":"J Robot Surg"},{"key":"key2026021020252300_ref54-bib54","volume-title":"Saving and Improving Lives: The Future of UK Clinical Research Delivery","author":"Department of Health and Social Care, Northern Ireland Executive, Welsh Government, Scottish Government"},{"key":"key2026021020252300_ref55-bib55","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1111\/ans.13856","article-title":"Systematic review of reusable versus disposable laparoscopic instruments: costs and safety","volume":"87","author":"Siu","year":"2017","journal-title":"ANZ J Surg"}],"container-title":["Health Technology Assessment"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2049920","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/sites\/journalslibrary\/files\/journal_data\/GJTC1718\/GJTC1718.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/njl-admin.nihr.ac.uk\/document\/download\/2049920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T15:01:03Z","timestamp":1770735663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.journalslibrary.nihr.ac.uk\/hta\/published-articles\/GJTC1718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":55,"alternative-id":["10.3310\/GJTC1718"],"URL":"https:\/\/doi.org\/10.3310\/gjtc1718","relation":{},"ISSN":["2046-4924"],"issn-type":[{"value":"2046-4924","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"This content has been made freely available to all.","name":"free","label":"Free to read"},{"value":"07-2020","name":"contractual_start_date","label":"contractual_start_date","group":{"name":"article_history","label":"Article History"}},{"value":"07-2024","name":"editorial_review_begun","label":"editorial review begun","group":{"name":"article_history","label":"Article History"}},{"value":"07-2025","name":"accepted_for_publication","label":"Accepted for publication","group":{"name":"article_history","label":"Article History"}}]}}