Success of outpatient hysterectomy: V-Notes versus Vaginal hysterectomy

Vaginal hysterectomy (VH) is the approach of choice for benign uterine conditions and is suitable for outpatient care. Many studies suggest that the vaginal natural orifice transluminal endoscopic surgery (V-Notes) technique is reliable and safe for outpatient surgery, but the literature includes only pilot studies with small cohorts. The aim is to assess the V-Notes technique compared to VH in outpatient settings with a larger cohort.

This is a retrospective cohort study including patients who underwent V-Notes or VH, scheduled as outpatient procedures, at Lille University Hospital between 2016 and 2022. Baseline characteristics and surgical outcomes were compared. The primary outcome was the success of outpatient surgery. Secondary outcomes were intraoperative and postoperative complication rates and factors limiting outpatient feasibility.

373 patients were included, 204 underwent V-Notes and 169 VH. In the V-Notes group there were more nulliparous women (27.9% vs 14.8 %, p < 0.002), more larger uteri (>280 g) (30.8% vs 12.9 %, p < 0.001) and more salpingectomy performed (98% vs 79.9 %, p < 0.001), compared with the VH group. The outpatient success rate did not differ significantly between the two groups (83.3% vs 79.9 %, p = 0.39, adjusted p = 0.50), even after adjusting for nulliparity, salpingectomy, and uterine weight greater than 280 g (adjusted OR 1.24), with no differences in complications or factors limiting outpatient feasibility.

V-Notes hysterectomy is a safe outpatient procedure, showing no differences for outpatient care success compared to VH, even for patients with larger uteri or nulliparity, while allowing for more salpingectomies. Additionally, the V-Notes approach appears promising for hysterectomies in nulliparous women or those with large uteri.