Evidence-based practical guidelines of the International Society for Gynecologic Endoscopy (ISGE) for vaginal hysterectomy

Perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single‐site surgery in hysterectomy: A comparative study

“…The International Society for Gynecologic Endoscopy (ISGE) has suggested that transvaginal hysterectomy is best for patients with a uterine size less than that noted in 12 weeks of gestation or uterine weight less than 280 g 23 . In this study, among the 157 patients who successfully completed total hysterectomy through vNOTES, 33 (21.0%, 33/157) had a uterine weight of >280 g, and nine of these had a uterine weight of >500 g. Therefore, a large uterus is not an absolute contraindication to vNOTES.…”

“…This also agrees with the recommendations of Baekelandt et al, which allows more women to be treated in a daycare setting. 22 The International Society for Gynecologic Endoscopy (ISGE) has suggested that transvaginal hysterectomy is best for patients with a uterine size less than that noted in 12 weeks of gestation or uterine weight less than 280 g. 23 In this study, among the 157 patients who successfully completed total hysterectomy through vNOTES, 33 (21.0%, 33/157) had a uterine weight of >280 g, and nine of these had a uterine weight of >500 g. Therefore, a large uterus is not an absolute contraindication to vNOTES. However, laparoscopy has been introduced into vNOTES for exploration of the pelvic cavity, making it possible to perform adnexectomy which is difficult because of the limited space available for traditional transvaginal hysterectomy.…”

The Influence of Obesity on Non-Descent Vaginal Hysterectomy (NDVH): A Retrospective Comparison of Obese and Non-Obese Women Undergoing NDVH

“…NDVH is considered the preferred method for treating benign uterine conditions when the uterus size is up to 12 weeks or up to 280 grams, in general and in obese women, as stated by authoritative organizations such as the ACOG 0n 2015, 2017 and its reaffirm in 2019, 2020 SOGC [28,29] , DHA [30] , ISGE [31] , and the SGS [32] . This preference is based on the costeffectiveness and value-based nature of NDVH compared to TAH and TLH of the Cochrane review of 42 and 62RCTs in 2015 and 2023 [1,33] .…”

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

“…In some cases, fibroids can grow to a size that requires surgical intervention, and hysterectomy is often the chosen treatment option (1,2) .Non-Descent Vaginal Hysterectomy (NDVH) is the genuine minimally invasive Hysterectomy (MIH) that involves the extirpation of the uterus through the natural orifice without the need for abdominal incisions as in total abdominal Hysterectomy (TAH) or abdominal cuts as in total laparoscopic Hysterectomy (TLH) or Robotic assisted laparoscopic Hysterectomy (RALH) (3,4) . As the NDVH is associated with high success rates, faster recovery times, lower morbidity rates , higher patient safety, higher security, efficient economics, excellent cosmesis, fewer perioperative morbidity, least complications, shortened operating time, reduced hospitalization, lesser costs, and quicker convalescence, the most prestigious gynecologic regularity authorities including American College of Obstetricians and Gynecologists (ACOG) in 2009 (5) ,2017 (6) ,2019 (7) , International Society for Gynecologic Endoscopy (ISGE)in 2018,2020 (8,9) , American Association of Gynecologic Laparoscopists (AAGL)in2011 (10) , Danish Health Authority in 2017 (DHA) (11) , National Institute for Health and Care Excellence (NICE) (12) ,Royal College of Obstetricians and Gynecologists (RCOG) (13) , Society Obstetrics and Gynecology of Canada(SOGC) in 2002 (14) ,2011 (15) ,2018 (16) ,2019 (17 ) , DGGG, OEGGG, SGGG collectively in 2015 (18,19) , and Society of Gynecologic Surgeons (SGS) (20), are recommending vaginal route for hysterectomy for treatment of benign gynecologic conditions for mobile uteri up to 280 gram, which corresponding clinically to 12 weeks gestational age uterine size, in at least women who underwent prior vaginal delivery with absent of prior lower abdominal surgical procedures including cesarean section. Also, the same recommendation had been reported in literature (20)(21)(22)(23)(24)(25) and Cochrane library reviews for surgical approach to hysterectomy for benign gynecologic disease of RCTs in 2005 (26) ,2006 (27) ,2009 (2...…”