Reviewer’s report
Title: 
Quality of life after laparoscopic hysterectomy versus abdominal hysterectomy
Version: 
3 
Date: 
02 May 2021
Reviewer's report:
The authors presented a retrospective study on the quality of life (QOL) over short and long time periods
following either laparoscopic hysterectomy (LH) or abdominal hysterectomy (AH). The topic of the article
is interesting, and the study well conducted and well explained in the manuscript. 
I enclose only some suggestions.
 Abstract/ Methods: "This study enrolled 28 patients who underwent total hysterectomy for uterine
fibroids in 2012 (14 AH cases and 24 LH cases) were enrolled in this study". From the data exposed it
seems that the number of patients is 38 and not 28. Furthermore, I would suggest you to specify the
number of patients enrolled in the results section rather than in the methods section.
 Lines 41-51: "We considered that although laparoscopy unequivocally yields smaller surface wounds, it
may be more accurately classified as a minimal access— rather than minimally invasive—procedure given
that the degree of intraabdominal maneuvering is similar to that required for open surgery".
This sentence is not totally correct because intra-abdominal manipulation by laparoscopic route is
notoriously less extensive than that by laparotomy (thanks to the use of small instruments and to the
amplified vision that allow performing a surgery of precision and thanks to the absence of a direct
manipulation of the intestinal loops); furthermore, the role of minimally invasive surgery in the prevention
of postoperative morbidity is wider as its advantages act at various levels of the inflammatory response to
surgical stress. I suggest you this article to learn more about this: 
DOI 10.1093/bja/78.5.606.
 Lines 35-45: "Thirty-eight patients who underwent total hysterectomy for uterine fibroids in 2012 (14
AH and 24 LH cases) were included. Of the 14 AH patients, 12 had uterine fibroids and two had
adenomyosis. Of the 24 LH patients, 19 had uterine fibroids and six had adenomyosis". I suggest you to
report these data in the results section and not in the section of methods.
 From Line 54: "In addition, no special protocol, such as ERAS, was used for postoperative
management, and the results were based on standard postoperative management." Please clarify if you are
referring to your study again, it is not clear in this sentence.
Kind regards.
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Is the study design appropriate to answer the research question (including the use of appropriate controls),
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manipulation?
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