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. 2024 Nov 29;24(1):631.
doi: 10.1186/s12905-024-03461-w.

Transvaginal natural orifice endoscopic surgery for hysterectomy: a prospective cohort study

Xian Wu #  1   2 , Xin Li #  3 , Aijie Xie #  1   2 , Jia Liu #  3 , Tianjiao Liu #  1 , Yunyi Su  1   2 , Ying Liu  1 , Wei Cheng  1 , Ying Jin  1 , Lulu Wang  1 , Yujian Jia  1 , Jianmei Liao  1 , Hui Wang  1 , Xia Yu  1   2 , Ling Zhang  1 , Yalan Li  4 , Li He  5   6 , Yonghong Lin  7   8 , Xiaoqin Gan  9   10
Affiliations

Transvaginal natural orifice endoscopic surgery for hysterectomy: a prospective cohort study

Xian Wu et al. BMC Womens Health. .

Abstract

Objective: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its advantages, including reduced postoperative pain and the absence of visible scarring. However, the anatomical specificity required for vNOTES may increase the risk of injury to nearby organs, such as the rectum and bladder. This study aims to evaluate the safety and potential benefits of vNOTES compared to transumbilical laparoendoscopic single-site surgery (LESS) for Hysterectomy.

Methods: The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), conducted in Chengdu, China, included 192 patients who underwent hysterectomy between May and October 2023. This study prospectively collected and compared perioperative and follow-up data between the two groups.

Results: The vNOTES group demonstrated shorter surgery times, postoperative flatus time, and hospital stays, but it also had a higher conversion rate. Specifically, the vNOTES approach reduced surgery duration by approximately 29.8 min (95% CI: -41.31, -18.34, P < 0.001) but increased intraoperative blood loss by about 41.82 mL (95% CI: 25.81, 57.82, P < 0.001).

Conclusion: By combining laparoscopy with traditional vaginal surgery, vNOTES offers advantages such as shorter surgery times, faster postoperative recovery, reduced hospital stays, greater minimal invasiveness, and improved cosmetic outcomes. However, it is essential for surgeons to continually enhance and standardize preoperative assessments and surgical techniques to minimize conversion rates and reduce intraoperative blood loss.

Trial registry number: ChiCTR2200059282, China Clinical Trials Registry, April 28, 2022.

Keywords: Enhanced recovery after surgery; Hysterectomy; Laparoscopes; Natural orifice endoscopic surgery; Prospective study.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study is based on a Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS) conducted in Chengdu (China Clinical Trials Registry ChiCTR2200059282, April 28, 2022) and approved by the Ethics Committee of Chengdu Women and Children’s Central Hospital (No. 202130). This study was conducted strictly in accordance with the Declaration of Helsinki. Before the surgery, all patients were well-informed of the potential risks and advantages of vNOTES and other alternative surgical treatments, including TU-LESS or multi-port laparoscopy, and expressed their preference for vNOTES. Written informed consent obtained from all the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The selection process for this study
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