Transvaginal natural orifice endoscopic surgery for myomectomy: Can it be a conventional surgery?

Abstract

IntroductionAs a new minimally invasive surgery, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been proved to be suitable for the treatment of a variety of gynecological benign diseases. However, compared with other minimally invasive surgeries that have been widely used, such as conventional multiport laparoscopy and transumbilical laparoendoscopic single-site surgery (LESS), their advantages and disadvantages and how to choose are still unknown. The purpose of our study is to compare the advantages and disadvantages of the three minimally invasive surgeries in myomectomy and to provide theoretical basis for the wider development of vNOTES surgery.Material and methodsThis retrospective study included 282 patients at our hospital who underwent laparoscopic myomectomy from May 2021 to March 2022. Based on the surgical approach, patients were classified into multiport, transumbilical LESS, and vNOTES groups. The patients’ demographic characteristics and follow-up data were collected during the perioperative period and at 1 month postoperatively.ResultsAmong the three procedures, vNOTES had the shortest anal exhaust time but also the highest postoperative infection rate. Multiple linear regression analysis showed that the operative time increased by 3.5 min for each 1 cm increase in myoma, and intraoperative bleeding increased by approximately 12 ml. The average duration of single pores increased by 25 min compared to that of multiports, and the operative duration increased by 10.48 min for each degree of adhesion.ConclusionsFor gynecologists who have mastered vNOTES, this procedure has the same efficacy and safety as the two existing minimally invasive surgeries in myomectomy, but it shows obvious advantages in postoperative recovery.

Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study

“…There was no significant difference in bleeding, duration of surgery, or drop in Hb or Hct between the two groups. The durations of surgery were slightly longer for the vNOTES group than the LESS group, which were consistent with the research of Hou et al [ 23 ].…”

“…In addition, 36 vNOTES patients (87.8%) and 84 LESS patients (63.2%) had an event of anal exhaust within 12 h after the operation, which are significantly different ( p = 0.002). Anal-exhaust time is an important observation index for early postoperative intestinal function recovery [ 23 , 24 ].…”

Posterior Uterine Fibroid Resection: Which Surgical Approach is More Suitable?

“…However, vNOTES, bene ting from its closer proximity to the target organ and the greater expansibility of the vaginal route compared to the umbilical route, can largely offset the disadvantages of LESS [10]. Moreover, as demonstrated in our previous study [11], vNOTES uterine broid resection can be performed as a routine procedure. Furthermore, in this study, we were delighted to nd that the prone position for broid resection resulted in shorter surgical times compared to the bladder ap position.…”

“…Previous studies have shown that transvaginal vault incision is a traditional surgical approach that provides safe access to the abdominal cavity, with a complication rate of only 1.3% [20]. In our previous research involving 2000 cases of vNOTES procedures, the incidence of visceral injury was as low as 0.4% [21]. Therefore, vNOTES can be routinely performed in gynecological surgeries and aligns with the principles of ERAS.…”

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

“…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.…”