Reviewer ’s report  
 
Title: Comparison of vaginal hysterectomy and laparoscopic hysterectomy: a systematic review 
and meta -analysis  
 
Version: 2 Date: 22 May 2019  
 
Reviewer: Antonio Simone Laganà  
 
Reviewer's report:  
 
I read with great interest the Manuscript titled "Comparison of vaginal hysterectomy and 
laparoscopic hysterectomy: a systematic review and meta -analysis" (BMWH -D-19-00172R2), 
which fal ls within the aim of BMC Women's Health.     
In my honest opinion, the topic is interesting enough to attract the readers' attention. The paper is 
well written and has important clinical messages. Nevertheless, authors should clarify some 
points and improv e the discussion citing relevant and novel key articles about the topic.  
Authors should consider the following recommendations:  
- Manuscript should be further revised by a native English speaker in order to correct 
several typos.  
- The Authors report that seventy percent of hysterectomies are performed for benign 
indications, including leiomyoma. Nevertheless, I think it is important to underline that 
the management of uterine myomas strictly depends on several factors, including 
position, number and volume . In case of submucous myomas, the possibility offered by 
hysteroscopy represents the actual gold standard for both diagnosis and treatment. I 
would stress this point, referring to: PMID: 28948169; PMID: 24950124; PMID: 
27040423.  
- The Authors correctly de scribe the progressive implementation of laparoscopic 
techniques, including laparoscopic -assisted vaginal hysterectomy (LAVH) and total 
laparoscopic hysterectomy (TLH). In this regard, I would stress the importance of 
laparoscopic surgery in the management  of gynecological diseases mentioning some 
recent articles about the topic: PMID: 27579309; PMID: 29444547; PMID: 27040423.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
Does the work include the necessary controls?  
If not, please specify which controls are r equired in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years rece ived reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way  gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or s alary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can a nswer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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on my report to the authors and, if the manuscript is accepted for publication, my named report  
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I agree to the open peer review policy of the journal