Transvaginal natural orifice transluminal endoscopic surgery in gynecological procedure: Experience of a Women's and Children's Medical Center from China

Huang, Lu; Feng, Dan; Gu, Ding‐Xian; Lin, Yonghong; Gong, Zhaolin; Liu, Dan‐Dan; Zhang, Qiang; Li, Yan; Huang, Liqiong; He, Lin

doi:10.1111/jog.15402

Cited by 13 publications

(9 citation statements)

References 25 publications

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“…It has been conducted in our institute for only 4 years. 17 We have performed 3000 cases of vNOTES so far, but because not many patients would suffer from another benign gynecological disease in such a short period after the first vNOTES, we did not have many patients who underwent a second vNOTES. Thus, we only had a few cases of repeated vNOTES, making the study on the repeatability of vNOTES challenging.…”

Section: Discussionmentioning

confidence: 99%

“…vNOTES is an emerging minimally invasive surgical technique, which has not been widely performed worldwide. It has been conducted in our institute for only 4 years 17 . We have performed 3000 cases of vNOTES so far, but because not many patients would suffer from another benign gynecological disease in such a short period after the first vNOTES, we did not have many patients who underwent a second vNOTES.…”

Section: Discussionmentioning

confidence: 99%

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Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

Feng

Liu

et al. 2023

J of Obstet and Gynaecol

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AimsTo investigate the perioperative outcomes and sexual function of patients undergoing repeated transvaginal natural orifice transluminal endoscopic surgery (vNOTES).MethodsWe retrieved the records of patients who underwent vNOTES twice at our institute between April 2019 and December 2022 and analyzed their baseline information and perioperative complications, and compared the pre‐ and postoperative sexual function of both vNOTES.ResultsPatients' mean age and body mass index were 29.00 ± 3.59 and 30.4 ± 4.00 years and 21.89 ± 3.69 and 22.76 ± 3.88 kg/m2, respectively, when receiving the first and second vNOTES. Ectopic pregnancy was the most frequent indication for vNOTES, with 7 cases in the first vNOTES and 11 cases in repeated vNOTES. The interval between the two vNOTESs ranged from 9 days to 38 months. The operation duration (63.33 ± 13.71 vs. 67.33 ± 22.51 min, p = 0.723), intraoperative estimated blood loss (32.00 ± 20.42 vs. 30.00 ± 9.26 mL, p = 0.429), and duration of postoperative hospital stay (2.20 ± 0.56 vs. 2.40 ± 0.51 days, p = 0.082) of both vNOTESs were comparable. No significant differences were found in any of the domains in the comparison of pre‐first and post‐first vNOTES, pre‐second and post‐second vNOTES, and pre‐first and post‐second vNOTES female sexual function index. None of the patients delivered after the second vNOTES.ConclusionRepeated vNOTES is safe and feasible. No significant change in the patients' sexual function was found in our cohort after the first and second vNOTES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

Feng

Liu

et al. 2023

J of Obstet and Gynaecol

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“…The vNOTES and TU-LESS procedures performed and the equipment applied in the present study will be similar to those described in previous publications. [24,33,41,42] Recruitment procedures and follow-up plan Recruitment: The enrolment owchart and follow-up plan for the CLOCKBEGIN study are shown in Fig. 1.…”

Section: Study Interventionsmentioning

confidence: 99%

Study Protocol Protocol for the Chengdu Longitudinal Cohort Study on vNOTES in Treating Benign Gynecologic Indications (the CLOCKBEGIN study): a Randomized Controlled Trial

Feng,

Liu,

et al. 2024

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Background Natural orifice transluminal endoscopic surgery (NOTES) is a series of novel and controversial minimally invasive surgical (MIS) approaches. NOTES performed in a transvaginal fashion (vNOTES) reportedly has many advantages over other NOTES approaches and is preferentially used for treating benign gynecologic conditions. However, the lack of detailed, large-scale perioperative and long-term postoperative data to support the feasibility and safety of vNOTES, especially on its impact on patients’ postoperative outcomes, remains contentious and may impede its acceptance in gynecology. Methods The Chengdu Longitudinal Cohort Study on vNOTES in Treating Benign Gynecologic Indications (the CLOCKBEGIN study) is a randomized controlled trial (RCT) that will recruit about 3,400 gynecologic patients with benign indications who underwent vNOTES or transumbilical laparoendoscopic single-site surgery for oviduct salpingostomy, tubal ligation, salpingectomy, ovarian cystectomy, adnexectomy, hysterectomy, or myomectomy. After obtaining the participants’ consent, a perioperative assessment and a 5-year postoperative follow-up with eight visits will be conducted. Data collection will be performed perioperatively and postoperatively at designated time points, e.g., 1st, 2nd, and 3rd postoperative day; 1st, 3rd, and 6th month; and 1st, 2nd, 3rd, 4th, and 5th year after the surgery. The baseline information collection will include subjects’ sociodemographics and their health- and gestation-related history obtained from the Hospital Information System and face-to-face interviews. As planned, perioperative and postoperative outcomes will be examined based on intraoperative assessment, in-patient clinical observation, and follow-up WeChat questionnaires or clinic services. Among these outcomes, long-term postoperative results, such as sexual function, pregnancy, vaginal delivery, and incisional hernia, will be the focus. Discussion The CLOCKBEGIN study aims to assess the perioperative and long-term postoperative outcomes of vNOTES in the treatment of major benign gynecologic conditions compared to TU-LESS, focusing on patients’ sexual function, pregnancy, vaginal delivery, and incisional hernia. This large cohort, two-arm, prospective CLOCKBEGIN study, incorporating a comprehensive long-term follow-up strategy and employing a double-blinded randomized RCT design, has the potential to furnish substantial and robust clinical evidence for refining and establishing guidelines for gynecologic vNOTES procedures. This initiative is also expected to enhance patients' perceptions and acceptance of this innovative minimally invasive surgical approach. Trial registration number: ChiCTROOC- 2200059282 (registered on April 28th, 2022)

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“…This study applied similar surgical methods and equipment as described in previous publications [6,9,10]. The detailed surgical procedures were as follows:…”

Section: Operating Procedures Of Vnotes Ovarian Cystectomymentioning

confidence: 99%

Learning Curve Analysis of Transvaginal Natural Orifice Transluminal Endoscopic Surgery in Treating Ovarian Cysts: A Retrospective Cohort Study

Feng,

Liu,

Xiao

et al. 2024

Preprint

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Background：Transvaginal Natural Orifice Transluminal Endoscopy (vNOTES) is regarded as a challenging surgical technique to learn but is promising in reducing perioperative pain and significantly improves the cosmetic outcomes. Previous studies on the learning curve analysis of vNOTES mainly focuses on the hysterectomy approach, while the vNOTES ovarian cystectomy’s learning curve was merely reported thought more frequently performed than vNOTES hysterectomy. Therefore, this study seeks to analyze the learning curve of three surgeons with varying levels of experience in performing endoscopic surgery for the treatment of ovarian cysts using vNOTES. Methods: A total of 127 patients with ovarian cysts of a variety of pathological types were treated by vNOTES ovarian cystectomy performed by three surgeons of different levels of endoscopic surgical experience. Each surgeon’s learning curve was plotted using the Cumulative Sum method and divided into three or four phases of technique learning at the turning point of the learning curve. The sociodemographic and clinical features of patients in each phase were then compared and factors potentially associated with operation time were also screened. Results: The learning curve was presented in four phases. The operation time (OT) was significantly shorter in phases II (53.66 ± 16.55 min) and IV (54.39 ± 23.45 min) as compared with phases I (68.74 ± 15.85) and III (75.93 ± 30.55) (p <0.001). More cases of serve pelvic adhesion and chocolate cyst were assigned in the later phases. The presence of pelvic adhesion [adjusted odds ratio (OR) 7.149 (0.506, 13.792), p = 0.035] and bilateral cyst [adjusted OR 16.996 (2.155, 31.837), p = 0.025], max diameter of cyst[adjusted OR 2.799 (0.174, 5.425), p = 0.037], and surgeon’s experience [adjusted OR -6.118 (-11.814, -0.423), p =0.035] were significantly associated with OT. Conclusion: There learning curve of ovarian vNOTES has four phases. vNOTES ovarian cystectomy could be mastered after performing seven, nine, and 16 cases by surgeons with the most, average, and least experience in gynecologic endoscopic surgeries. Trial registration: ChiCTR2200059282 (Registered on April 28th, 2022)

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Transvaginal natural orifice transluminal endoscopic surgery in gynecological procedure: Experience of a Women's and Children's Medical Center from China

Cited by 13 publications

References 25 publications

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

Repeated transvaginal natural orifice transluminal endoscopic surgery: An initial Chinese experience

Study Protocol Protocol for the Chengdu Longitudinal Cohort Study on vNOTES in Treating Benign Gynecologic Indications (the CLOCKBEGIN study): a Randomized Controlled Trial

Learning Curve Analysis of Transvaginal Natural Orifice Transluminal Endoscopic Surgery in Treating Ovarian Cysts: A Retrospective Cohort Study

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