Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 May 10;4(2):100355.
doi: 10.1016/j.xagr.2024.100355. eCollection 2024 May.

Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery hysterectomy versus vaginal hysterectomy for benign indications

Greg J Marchand  1 , Hollie Ulibarri  1 , Amanda Arroyo  1 , Madison Blanco  1 , Daniela Gonzalez Herrera  1 , Brooke Hamilton  1 , Kate Ruffley  1 , Ali Azadi  2   3
Affiliations
Review

Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery hysterectomy versus vaginal hysterectomy for benign indications

Greg J Marchand et al. AJOG Glob Rep. .

Abstract

Objective: As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications.

Data sources: We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023.

Study eligibility criteria: We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications.

Study appraisal and synthesis methods: We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool.

Results: We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=-44.70 [-99.97, 10.57]; P=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=-0.16 [-1.62, 1.30]; P=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications.

Conclusion: vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.

Keywords: TVH; vNOTES; vaginal hysterectomy; vaginal surgery.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow diagram summarizing the results of our search.
Figure 2
Figure 2
Meta-analysis of operative time in minutes.
Figure 3
Figure 3
Meta-analysis of surgeon declared estimated blood loss, in mL.
Figure 4
Figure 4
Meta-analysis of hospital stay, in days.
Figure 5
Figure 5
Meta-analysis of Visual Analogue Scale (VAS) pain scores on postoperative day 1.
Figure 6
Figure 6
Meta-analysis of the rate of intraoperative complications.
Figure 7
Figure 7
Meta-analysis of the rate of postoperative complications.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Reboul Q, Mehdi A, Chauleur C. L'hystérectomie par voie vaginale en ambulatoire : étude de faisabilité et de satisfaction des patientes. Gynécol Obs Fertil Sénol. 2018;46:65–70. - PubMed
    1. Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;2015:2–3. - PMC - PubMed
    1. Pickett CM, Seeratan DD, Mol BWJ, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2023;2023:2–3. - PMC - PubMed
    1. Moen MD, Noone MB, Elser DM. Natural orifice hysterectomy. Int Urogynecol J. 2008;19:1189–1192. - PubMed
    1. Su H, Yen C-F, Wu K-Y, Han C-M, Lee C-L. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012;51:217–221. - PubMed