vNOTES Hysterectomy with Sentinel Lymph Node Mapping for Endometrial Cancer: Description of Technique and Perioperative Outcomes

Abstract

To explore the technique and clinical value of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its perioperative outcomes with those of laparoscopic staging. Design: Retrospective cohort study. Setting: Department of gynecology at a tertiary medical center. Patients: All women diagnosed with endometrial cancer who underwent minimally invasive surgery at our center between August 2017 and May 2020. Interventions: Both vNOTES and laparoscopic approaches were used for hysterectomy and SLN mapping. The success of SLN detection as well as perioperative outcomes were subsequently analyzed. Measurements and Main Results: This study included 74 patients; 23 patients underwent vNOTES surgery, whereas 51 underwent standard laparoscopic surgery. The total successful SLN detection was 95.7% in the vNOTES group and 92.2% in the laparoscopy group (p >.05), whereas the bilateral success rates were 87.0% and 90.2%, respectively. No difference in SLN detection was observed between the 2 groups in terms of the side-specific mapping efficacy quotient (91.3% vs 91.2%, p = .47). The number of harvested SLNs, operative time, estimated blood loss, and intraoperative complications in the 2 groups were similar. One (4.3%) postoperative complication occurred in the vNOTES group vs 4 (7.9%) in the laparoscopy group (p = .029), and the median postoperative hospital stay was 3 days vs 4 days (p = .003). Conclusion:This study suggests that the vNOTES procedure is feasible, with a potentially decreased postoperative hospital stay, faster recovery, and better cosmetic results. However, prospective research is needed to validate its broader clinical application.

Transvaginal natural orifice transluminal endoscopic surgery (VNOTES) total retroperitoneal sentinel lymph node biopsy for an endometrial cancer patient with prior colon cancer surgery

“…6 A retrospective study from China showed that the vNOTES procedure is feasible, with a potentially shorter post-operative hospital stay, faster recovery, and better cosmetic results in patients with endometrial cancer. 7 The retroperitoneal vNOTES procedure has the advantage that it can be used in patients with endometrial cancer to avoid bowel injury during entrance to the abdominal cavity, both in patients with a previous midline incision and in those undergoing first surgery. The difficulty of correctly getting within the bilateral retroperitoneal spaces was the factor determining the appropriate site of vaginal incision, use of blunt dissections to reach the obturator fossa, and placement of the device.…”

vNOTES: Is it the Panacea We Are All Hoping for?

“…To allow the port to stay in place vaginally, the authors [7] also recommended completion of the anterior repair prior to the HUS ligament suspension, a change in the order of the flow compared to what is done traditionally. In the retrospective cohort study by Wang et al [9], this early experience with vNOTES hysterectomy and SLN was found to be comparable in perioperative outcomes to laparoscopy.…”

“…These span initially from simple procedures such as salpingectomy, ovarian cystectomy, oophorectomy, and hysterectomy for benign indications, to now more complex procedures for urogynecologic and oncologic applications. In this issue, we feature three papers with accompanying videos that demonstrated the incorporation of vNOTES after conventional VH to facilitate what can be difficult transvaginal procedures -the high uterosacral ligament suspension (HUS) [7], sacrocolpopexy [8] for prolapse and sentinel node dissection (SLN) for early-stage endometrial cancer [9]. Many helpful tips and nuances to the vNOTES technique that come aptly from experienced surgeons were highlighted.…”

“…The vNOTES articles we feature in this issue utilized conventional laparoscopic instruments [7,9] and the singlesite robotic system (DaVinci Xi Single-Site, Intuitive Surgical, Sunnyvale, CA) [8] through the transvaginal route. In March of 2021, the US Food and Drug Administration approved a new robotically-assisted device (Hominis Surgical System by Memic Innovative Surgical Ltd., Yehuda, Israel) for the performance of transvaginal hysterectomy and adnexectomy [10].…”

Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Surgical Staging of Early-Stage Ovarian Cancers: A Report of Two Cases

“…In recent years, vNOTES has been increasingly applied to perform benign gynecologic procedures such as hysterectomy, myomectomy, several adnexal procedures, uterosacral ligament suspension, and sacrocolpopexy (14)(15)(16). To date, the role of vNOTES in gynecological oncology still requires evaluation, as only a few studies have reported on it (17)(18)(19)(20)(21)(22)(23).…”