Does Regional Anesthesia Improve Recovery After vNOTES Hysterectomy? A Comparative Observational Study

Area of Science:

• Minimally invasive gynecologic surgery
• Anesthesiology
• Surgical innovation

Background:

• Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a preferred minimally invasive approach for benign hysterectomy.
• General anesthesia is standard, but regional anesthesia like combined spinal epidural anesthesia (CSEA) may improve postoperative outcomes.
• Limited comparative data exists for anesthetic techniques in vNOTES hysterectomy.

Purpose of the Study:

• To compare CSEA with general anesthesia (GA) for benign vNOTES hysterectomy.
• To evaluate differences in postoperative nausea and vomiting (PONV), recovery quality, and intraoperative safety.
• To assess patient satisfaction and functional recovery milestones.

Main Methods:

• Retrospective cohort study of 140 patients undergoing benign vNOTES hysterectomy.
• Comparison between patients who received CSEA versus GA.
• Outcomes included PONV incidence, post-anesthesia care unit (PACU) stay, pain scores, functional recovery, and patient satisfaction.
• Intraoperative physiologic parameters and complication rates were analyzed.

Main Results:

• CSEA was associated with significantly lower PONV incidence (aOR 0.32) and reduced pain scores in the first 24 hours.
• Patients under CSEA experienced shorter PACU stays and achieved earlier ambulation and oral intake.
• CSEA group reported higher overall patient satisfaction.
• Neuraxial anesthesia (CSEA) led to more transient hypotension and bradycardia; GA had higher airway pressures and lower oxygen saturation.

Conclusions:

• CSEA may enhance recovery and patient comfort after benign vNOTES hysterectomy compared to GA.
• While CSEA showed potential benefits, it was linked to transient hemodynamic instability.
• Findings are exploratory; individualized anesthesia choice is recommended, balancing recovery benefits against hemodynamic risks.
• Larger studies are needed to confirm these results and define optimal patient selection.