Isobaric NOTES hysterectomy: an alternative to transvaginal NOTES hysterectomy

Area of Science:

• Minimally Invasive Gynecological Surgery
• Surgical Innovation
• Endoscopic Procedures

Background:

• Conventional natural orifice transluminal endoscopic surgery (NOTES) hysterectomy often uses CO₂ pneumoperitoneum, leading to challenges like gas leakage and procedural complexity.
• Transvaginal NOTES hysterectomy (vNH) necessitates specific techniques to manage pneumoperitoneum.
• An alternative approach is needed to simplify the procedure and improve safety.

Purpose of the Study:

• To introduce and evaluate isobaric NOTES hysterectomy (iNH) as a novel alternative to transvaginal NOTES hysterectomy (vNH).
• To eliminate the requirement for CO₂ pneumoperitoneum in NOTES hysterectomy.
• To compare the clinical outcomes of iNH with single-port laparoscopy-assisted vaginal hysterectomy (SP-LAVH).

Main Methods:

• A retrospective comparison of clinical outcomes between iNH and SP-LAVH procedures.
• 137 patients with benign uterine conditions were included in the study.
• Data collected included operative times, blood loss, postoperative hemoglobin changes, and hospital stay.

Main Results:

• 59 patients underwent iNH and 78 underwent SP-LAVH.
• iNH procedures showed no intraoperative complications and minimal conversion rates.
• iNH resulted in significantly lower blood loss, reduced postoperative hemoglobin drop, and shorter hospital stays compared to SP-LAVH.

Conclusions:

• Isobaric NOTES hysterectomy (iNH) is a distinct transvaginal hysterectomy method that combines vaginal hysterectomy simplicity with enhanced visualization.
• The iNH approach, utilizing a single-hole vaginal platform without pneumoperitoneum, offers significant advantages over conventional methods.
• Further research is recommended to fully elucidate the benefits of iNH compared to pneumoperitoneum-based vNOTES.