A Cochrane review included 6 trials. In comparison of minilaparotomy vs laparoscopy there was no difference in major morbidity; minor morbidity was significantly less in the laparoscopy group (OR 1.89, 95% CI 1.38 to 2.59, n = 2106). Duration of operation was about 5 minutes shorter with laparoscopy (WMD 5.34 minutes, 95% CI 4.52 to 6.16 minutes). In comparison of minilaparotomy vs culdoscopy (endoscopy through the vaginal cul-de-sac) there was more major morbidity in the culdoscopy group (OR 0.14, 95% CI 0.02 to 0.98, n = 592). Duration of operation was about 5 minutes shorter with culdoscopy (WMD 4.91 minutes, 95% CI 3.82 to 6.01 minutes). In comparison of laparoscopy vs culdoscopy there were no significant differences between the groups with regard to major morbidity, but significantly more women suffered from minor morbidities in the culdoscopy group (OR 0.20, 95% CI 0.05 to 0.77, n = 198).
Authors' conclusions: Practical aspects (e.g. cost, maintenance, and sterilisation of the instruments) must be taken into account before implementing the more sophisticated endoscopic techniques in settings with limited resources. Culdoscopy is not recommended.
Comment: The quality of evidence is downgraded by sparse data and relatively short follow-up.