The outcomes of transvaginal NOTES hysterectomy in various uterine sizes

Temtanakitpaisan, Teerayut; Huang, Chung-Yuan; Jaiswal, Amruta; Yen, Chih-Feng; Lee, Chyi‐Long

doi:10.1016/j.tjog.2018.10.013

Cited by 25 publications

(18 citation statements)

References 19 publications

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“…Among the 114 cases, there was only 1 conversion to laparotomy for specimen removal after hysterectomy had been completed through vNOTES. This conversion rate of 0.9% (1/ 114), or 11.1% (1/9) in cases with very large uteri (>1000 g), is lower than that reported by Temtanakitpaisan et al (2.1% and 35.3%, respectively) [12]. There were no injuries to the ureter, bladder, or intestine in our retrospective cohort.…”

Section: Discussioncontrasting

confidence: 68%

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

Nulens

Bosteels

Rop

et al. 2021

Journal of Minimally Invasive Gynecology

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To evaluate the outcome of hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) in cases with a large uterus. Design: A retrospective cohort study. Setting: Belgian teaching hospital. Patients: Women who underwent a vNOTES hysterectomy from March 2015 to March 2020 for benign gynecologic disease with a uterine weight of 280 g or more on pathologic examination (N = 114). Interventions: All women underwent vaginally assisted NOTES hysterectomy. We performed a retrospective analysis of baseline patient characteristics and clinical outcomes. Measurements and Main Results: The mean age was 50 § 3.5 years. Twenty-two (19%) patients were obese (body mass index ≥30 kg/m 2), and 4 (3.5%) were morbidly obese (body mass index ≥40 kg/m 2). Thirty-five (31%) patients were nulliparous, and 15 (13%) women had 1 or more cesarean sections in their medical history. Uterine weight varied from 281 g to 3361 g, with a mean weight of 559 § 425 g. Mean surgical time was 63 § 34 minutes. Surgical time was positively associated with uterine size. There were 4 complications: 3 bleeding complications in the first 24 hours after surgery and 1 minor late complication. Conversion to laparotomy for specimen extraction was performed in 1 case (conversion rate 0.9%). There were no conversions to laparoscopy. No ureteric, bladder, or intestinal injuries occurred in this case series, and there were neither life-threatening complications nor intensive care unit admissions. Conclusion: The vNOTES technique can offer a safe and effective alternative to laparoscopy or laparotomy in cases with a large to very large uterus, even if the patient has a history of cesarean section, obesity, or nulliparity. In 99% of all women in this study, hysterectomy was successfully performed through vNOTES without conversion. By making use of the advantages of endoscopic surgery, vNOTES might broaden the indications of vaginal hysterectomy. Randomized controlled trials are needed to evaluate whether vaginally assisted NOTES hysterectomy is superior to laparoscopic or abdominal hysterectomy in large uteri cases.

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Section: Discussioncontrasting

confidence: 68%

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

Nulens

Bosteels

Rop

et al. 2021

Journal of Minimally Invasive Gynecology

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“…This leaves the question of what the uterine volume limit for performing vNOTES is. The largest uterus in our cohort weighed 320 g. However, in a study conducted by Temtanakitpaisan et al, 18 involving 17 patients who underwent vNOTES, the uterine weights were greater than 1 kg. In their study, patients were divided into three groups according to uterine weight (e.g., less than 500 g, 500–999 g, and 1 kg or more).…”

Section: Discussioncontrasting

confidence: 52%

Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study

Badiglian-Filho

Faloppa

Menezes

et al. 2020

Intl J Gynecology & Obste

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Objective To compare vaginally‐assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) hysterectomy with salpingectomy/salpingo‐oophorectomy with standard laparoscopic access. Methods Medical records for patients undergoing hysterectomy with adnexectomy for benign disease indication between February 1, 2019 and February 1, 2020 were retrospectively examined. Exclusion criteria were endometriosis, previous pelvic radiotherapy, inflammatory pelvic disease history, any other concurrent surgery, laparotomy, robotic surgery, and/or traditional vaginal hysterectomy. Results Among 86 patients, 21 (24.4%) were allocated to a vNOTES group and 65 (75.6%) were allocated to a conventional laparoscopy (LAP) group. Mean ages for the groups were 47.19 ± 11.11 years and 46.69 ± 9.11 years, respectively (P = 0.928). There were no statistically significant differences in age, body mass index, arterial hypertension/diabetes, smoking, menopausal status, obstetric history, number of abdominal surgeries, or preoperative hemoglobin level between the two groups. The mean (range) operative times were 111.90 min (80–180 min) in the vNOTES group and 113.98 min (64–350 min) in the LAP group (P = 0.904). There were no statistically significant differences in terms of surgery indication, specific and unspecific complications, conversions, blood transfusion, reoperation, significant ileus/emesis, and hospital stay. Conclusions Based on the parameters assessed, we found vNOTES to be comparable to laparoscopy among our cohort.

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“…The previous publications have confirmed vNOTES to be a safe and feasible procedure for hysterectomy and adenextomy [3,4]. However, there were no literatures reported about vNOTES hysterectomy in large uterus, especially in uterus weighing ≥1 kg (kg).…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Hua

et al. 2020

BMC Surg

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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.

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The outcomes of transvaginal NOTES hysterectomy in various uterine sizes

Cited by 25 publications

References 19 publications

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients

Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study

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

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