4.1 Main findings
We demonstrated that the use of IU manipulators did not result in poorer oncological outcome than the use of non-IU manipulators during TLH in early-stage, low-grade EEC in a longitudinal and nationwide study in the Netherlands. No differences were observed between IU and non-IU manipulators in recurrence, DFS, and OS. Secondarily, no association was found between site of recurrence and type of manipulator. However, manipulator preferences differed significantly by type of hospital. Non-IU manipulators were predominantly used in academic hospitals, whereas IU manipulators were mostly used in general and teaching hospitals. Our survey also revealed that these preferences changed within some hospitals over the years.