Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy

Baekelandt, Jan

doi:10.1016/j.jmig.2015.05.015

Cited by 94 publications

(87 citation statements)

References 19 publications

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“…We searched the CROWN database (http://www.crown-initiative.org) for a core outcome set on hysterectomy for benign disease and found no match. We therefore decided to contact ten women treated by total vaginal NOTES hysterectomy in an observational study published by our group for a short interview by telephone . We asked women whether they would have preferred leaving the hospital on the day of the hysterectomy and the risk of conversion of a new surgical technique they would accept if this new technique could avoid visible surgical scars.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial

Baekelandt

Mulder

Roy

et al. 2018

BJOG

127

170

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Objective To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) versus total laparoscopic hysterectomy (TLH) as a day-care procedure.Design Parallel group, 1:1 randomised single-centre single-blinded trial, designed as a non-inferiority study with a margin of 15%.Setting Belgian teaching hospital.Population Women aged 18-70 years scheduled to undergo hysterectomy for benign indications.Methods Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors.Main outcome measures The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12 hours after hysterectomy and the length of hospital stay as secondary outcomes. Results We randomly assigned 70 women to vNOTES (n = 35) or TLH (n = 35). The primary endpoint was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the TLH group: the onesided 95% upper limit for the differences in proportions of conversion was estimated as 7.5%, which is below the predefined non-inferiority margin. More women left the hospital within 12 hours after surgery after vNOTES: 77 versus 43%, difference 34% (95% CI 13-56%), P = 0.007. The hospital stay was shorter after vNOTES: 0.8 versus 1.3 days, mean difference À0.5 days, (95% CI À0.98 to À0.02), P = 0.004.Conclusions vNOTES is non-inferior to TLH for successfully performing hysterectomy without conversion. Compared with TLH, vNOTES may allow more women to be treated in a day-care setting.Keywords Core outcome set, day-care surgery, laparoscopic hysterectomy, randomised controlled trial, vNOTES.Tweetable abstract RCT: vNOTES is just as good as laparoscopy for successful hysterectomy without conversion but allows more day-care surgery.Please cite this paper as: Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BWJ, Bosteels JJA. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG 2019;126:105-113.

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Section: Methodsmentioning

confidence: 99%

“…Our hypothesis was that women would accept a higher conversion rate of 15% for vNOTES driven by their preference to avoid visible scars. We refer to the telephone interview of 10 women treated by total vaginal NOTES hysterectomy . Women were asked to choose among five cut‐off rates (5, 10, 15, 20 or 25%).…”

Section: Methodsmentioning

confidence: 99%

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial

Baekelandt

Mulder

Roy

et al. 2018

BJOG

127

170

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“…Also, it shortens the recovery time and reduces postoperative pain. In fact, because hybrid V-NOTES is performed through natural orifices, it decreases the inflammatory and neuroendocrine responses [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In hybrid NOTES, the surgical procedure is performed through a natural body orifice with transabdominal assistance [ 8 ]. Restricted visualization and limited operative capabilities can be present in some complex NOTES procedures, and these disadvantages can be overcome with a hybrid NOTES procedure.…”

Section: Introductionmentioning

confidence: 99%

Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology

Terzi

Türkay

Uzun

et al. 2018

International Journal of Surgery Case Reports

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“…Other groups [6] [7] [8] have also described their initial experience with transvaginal NOTES using a single port and concluded that transvaginal NOTES was a feasible and effective surgical technique in properly selected female patients with adnexal masses. Hysterectomy via the vaginal route was first reported by Su et al [9] in the same year; however it was Baekelandt et al [10] that reported the first total vNOTES hysterectomy (TVNH), in which the entire procedure was performed using transvaginal NOTES under the pneumovagina.…”

Section: Vaginal Approachmentioning

confidence: 99%

Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept

Alshiek¹,

Bar-El²,

Shobeiri³

2019

OJOG

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Objective: To gain insight into the feasibility and safety of a novel vaginal robot for performing supracervical hysterectomy in an ovine model. Introduction: The clinical application of transvaginal natural or fice transluminal endoscopic surgery (vNOTES) has broadened significantly. vNOTES reduces wound complications such as infection, hematoma formation, or herniation and is currently utilized for hysterectomy, adnexal surgery, myomectomy, and staging surgery for endometrial cancer. Robotic assistance has been proposed to overcome the current vNOTES mechanical obstacles. The implementation of the current robots has limited utility due to their bulk and inflexibility. Robotic Natural Orifice Transluminal Surgery (rNOTES) is the new frontier in advancement of surgical robots. In developing new task specific robots, it is important to utilize an accurate model for testing. A novel vaginal robot introduced through the posterior cul-de-sac to perform a complete retrograde hysterectomy is the subject of this study. Methods: The study was conducted at the animal lab, Asaf-Harofe hospital, Israel. The ovine model was preferred since the anatomical landmarks and vascular anatomy are comparable to the human except for a bicornuate uterus in sheep. A vaginal robotic supra-cervical hysterectomy was performed in a sheep. Results: A vaginal robotic supracervical hysterectomy was performed successfully in an ovine model. The uterus was extracted via the entry point in the pouch of Douglas. 20 cc of blood loss was reported and no complications were observed. Conclusions: Vaginal supracervical hysterectomy via a vaginal approach using a novel robotic system was found to be feasible.

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Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy

Cited by 94 publications

References 19 publications

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial

Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial

Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology

Vaginal Robotic Supracervical Hysterectomy in an Ovine Animal Model: The Proof of Concept

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