Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery versus single‐port laparoscopy: Comparison of early outcomes

Abstract

Aim: The study objective was to compare intraoperative and early postoperative outcomes among patients who underwent hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (and singleport lararoscopy for presumed benign gynecologic disorders). Methods: We retrospectively reviewed 40 patients who underwent single-port laparoscopic hysterectomy and 20 patients who underwent hysterectomy via natural orifice transluminal endoscopic surgery. Patients' age, body mass index, history of previous delivery and surgery, total operation time (from skin incision to closure), intraoperative and postoperative complications conversion to another surgical procedure, drop of hemoglobin level, postoperative pain at 1 and 18 h, average hospital stay, and clinical outcomes were analyzed. Results: Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery was superior to single-port hysterectomy concerning the length of hospitalization (p < 0.001) and visual analog scale at 1 h (p = 0.024) and 18 h (p < 0.001). In transvaginal natural orifice transluminal endoscopic group, postoperative complications were lower than single-port laparoscopy group (p = 0.023). In transvaginal natural orifice transluminal endoscopy, group conversion to a standard vaginal hysterectomy occurred in two cases (10%). Four patients in the single-port laparoscopic hysterectomy group had umbilical herniation, three had portsite infections, and two patients had vaginal cuff hematoma. These patients required rehospitalization. Conclusions: Despite hysterectomy via transvaginal natural orifice transluminal surgery has not yet found its place in routine practice in gynecology departments, it could be a prominent alternative approach to other minimally invasive surgical procedures in selected patients with many advantages including lesser pain and lower complication rates compared with single-port laparoscopic hysterectomy.

Comparison of Surgical Outcomes of Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus Single-Port Access (SPA) Surgery

“…It was also found that patients who underwent vNOTES experienced less postoperative pain than those who underwent SPA laparoscopic surgery, and the total operative time of vNOTES was shorter than that of SPA laparoscopic surgery. To the best of our knowledge, the present study is the third to compare the surgical outcomes of vNOTES and SPA hysterectomy [ 12 , 13 ]. Both previous studies have demonstrated comparable surgical outcomes of vNOTES to those of SPA laparoscopic surgery, but those studies were conducted retrospectively whereas the present study was designed as a prospective cohort study.…”

“…Furthermore, a comparative investigation of the surgical outcomes of vNOTES and SPA laparoscopic surgery has not been conducted to date. To the best of our knowledge, only two studies have compared the operative outcomes of vNOTES and SPA laparoscopic surgery [ 12 , 13 ]. The present study aimed to compare the two surgical methods.…”

Technical, ergonomic and cognitive learning methodology in transumbilical single‐port laparoscopic hysterectomy

“…32 However, experienced surgeons can minimize the risk of complications compared with other surgical routes. 33 Although hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) has the advantage of no abdominal wall incisions compared with single-port hysterectomy, 34 factors such as increased technical difficulty and limited mobility of the uterus can limit its practicality. Conversely, laparoscopic hysterectomy offers several advantages over robotic-assisted hysterectomy, including lower cost, shorter surgical time, fewer ports needed, and similar outcomes.…”

Single-port laparoscopic sacrospinous ligament suspension via the natural vaginal cavity (SvNOTES) for pelvic prolapse: The first feasibility study

“…Compared with conventional transvaginal surgery, the surgical field of SvNOTES can be clearly visualized using an endoscopic camera; any pathology beyond the reach of the operator can be easily managed with the assistance of laparoscopic instruments ( 18 , 19 ). More importantly, it has the advantage of the absence of abdominal scarring ( 20 ).…”