Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for uterus weighing ≥1 kg

Abstract

Background The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) applied in gynecology has been developed recent years and been evolving. In this study, we aimed to evaluate the feasibility and effect of the vNOTES hysterectomy for uterus ≥1 kilogram (kg). Methods From January 2019 to March 2020, patients with benign indications in cases of uterus weighing ≥1 kg, underwent vNOTES hysterectomy were studied retrospectively. The patients’ demographics, indications for surgery, operation outcomes and follow-up details were recorded. Results 39 patients were performed vNOTES hysterectomy for large uterus (mean weight 1141.8 gram, range from 1000 to 1720), indications for surgery included bulky uterine myomas or adenomysosis. The mean age was 48 years (range 42–66) and mean BMI was 24 kg/m2 (range 18.4–38). Mean operating time was 123.3 min (rang 40–400) and the mean estimated blood loss was 206.7 milliliters (range 10–1300). The mean pain assessment was 2.1 (range 0–5). The mean length of stay was 2.4 nights (1–11). 1 patient experienced ureteral injury and was performed ureteral anastomosis. 3 patients were converted to vaginal-assisted trans-umbilicus single-port laparoscopy. The learning curve was analyzed to show that 20 cases were needed to achieve proficiency in vNOTES hysterectomy for large uterus ≥1 kg. Conclusion Our preliminary experience suggested that vNOTES hysterectomy for large uterus weighing ≥1 kg was feasible and safe, meanwhile this procedure had the advantages of all the minimal invasive approach such as fast recovery and aesthetic advantage.

Evaluation of the learning curve and safety outcomes in robotic assisted vaginal natural orifice transluminal endoscopic hysterectomy: A case series of 84 patients

“…Currently, there are no published studies available to address the learning curves of R‐vNOTES for hysterectomy through two different methodologies. Previous data demonstrate that the surgeon’s learning curve for traditional vNOTES hysterectomy in benign gynecology was approximately 10–25 cases, 21,34,35 and 9–50 cases were needed to achieve stability for robotic‐assisted hysterectomy 31,34,36,37 . Since total operative time is greatly affected due to additional surgical procedures, we created the learning curve based on the robot docking time, port placement time and hysterectomy times in this study.…”

“…Previous data demonstrate that the surgeon's learning curve for traditional vNOTES hysterectomy in benign gynecology was approximately 10-25 cases, 21,34,35 and 9-50 cases were needed to achieve stability for robotic-assisted hysterectomy. 31,34,36,37 Since total operative time is greatly affected due to additional surgical procedures, we created the learning curve based on the robot docking time, port placement time and hysterectomy times in this study. The 84 cases in this study were all completed by a single experienced gynaecologic surgeon.…”

Enabling Technologies for Gynecologic Vaginal Surgery

“…Of these, 39 were excluded because they did not meet eligibility criteria. Thus, 116 studies were included in the final analysis, 11,23–137 including 15 RCTs, 17 nonrandomized comparative studies, and 84 single-group studies (Fig. 1).…”

Applications of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgery

“…A retrospective study of VNH for uterine weight ≥280 g had one conversion to laparotomy for specimen extraction, however, VNH was successful with uterine weight up to 3361 g [12 ▪ ]. A study of VNH for uteri ≥1 kg reported a high rate of conversion (7.7%), however, the secondary approach was traditional laparoscopy, and laparotomy was avoided in all cases [13 ▪ ]. In comparative studies of patients with large uteri, VNH was favorable over TLH for operative time, hospitalization, and postoperative pain scores with similar blood loss and complications [14 ▪ ].…”