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Published on: January 17, 2019
Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri
Nour Kheirbek1, Victoire Delporte1, Houssein El Hajj2
1Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France.
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for large uteri significantly reduces operative time and hospital stay compared to conventional laparoscopy. This minimally invasive approach also increases ambulatory surgery rates, offering a more efficient treatment option.
Area of Science:
- Minimally Invasive Gynecologic Surgery
- Surgical Technology Innovation
Background:
- Hysterectomy is a common gynecologic procedure.
- Large uteri present surgical challenges for minimally invasive approaches.
- Conventional laparoscopic hysterectomy (LH) has limitations for large uteri.
Purpose of the Study:
- To compare the outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with conventional laparoscopic hysterectomy (LH) for large uteri (>280 g).
- To evaluate the feasibility and safety of vNOTES for this patient population.
Main Methods:
- Retrospective cohort study comparing 54 vNOTES hysterectomies with 52 conventional LH procedures for large uteri.
- Assessment of baseline characteristics and surgical outcomes including operative time, bleeding, complications, and hospital stay.
- Analysis of patient management in ambulatory versus inpatient settings.
Main Results:
- vNOTES hysterectomy demonstrated a significant reduction in operative time (99 vs. 171 minutes) and hospital stay (0.5 vs. 2 nights) compared to LH.
- A higher percentage of vNOTES procedures were performed in an ambulatory setting (50% vs. 3.7%).
- No significant differences were observed in intraoperative bleeding or conversion rates; complication rates were low for both approaches.
Conclusions:
- vNOTES hysterectomy is a viable and effective alternative to conventional LH for patients with large uteri.
- The procedure is associated with improved efficiency, shorter recovery, and increased ambulatory care potential.
- vNOTES represents a significant advancement in minimally invasive surgical options for complex hysterectomies.
