Clinical study of hysteromyomectomy via transvaginal natural orifice transluminal endoscopic surgery by posterior approach

Abstract

Objective To explore and establish the value of the technique and application of transvaginal vaginal natural orifice transluminal endoscopic surgery(vNOTES)by posterior approach in myomectomy. Methods 21 patients with hysteromyoma of posterior wall who underwent hysteromyomectomy via vNOTES from Nov. 2017 to Mar. 2019 in Shanghai First Maternity and Infant Hospital were selected. Then clinical data including operation time, blood loss, postoperative complications, postoperative hospital stay, postoperative pain score, and recovery time of intestinal function were collected and analyzed. Results One case was transferred to transumbilical single-port laparoscopy due to failure of posterior approach, and the operation did not cause any organ damage. The other 20 cases were successfully completed. The age of 20 patients ranged from 32 to 48 years, with an average age of (39.9±4.2) years; body mass index 17.63-23.03 kg/m2, with an average of (20.7±1.73) kg/m2; operation time was 80-135 min, with an average of (116.07±23.38) min; The diameter of the leiomyoma was 5-9 cm, with an average of (6.96±1.22) cm; the intraoperative blood loss was 50-300 ml, with an average of (78.57±69.93) ml; the VAS score was 2-4 at 12 hours after operation, with an average of (2.14±0.66) points; the postoperative exhaust time was 12-46 h, with an average of (28.57±7.42) h; the postoperative hospital stay was 2.5-4 days, with an average of (3.3±0.67) days. There was no conversion to open surgery, no blood transfusion, no surgical complications, no urinary and intestinal injuries and poor wound healing occurred. Conclusions Hysteromyomectomy via vNOTES is a safe and feasible option for posterior hysteromyoma, and is more minimally invasive than transumbilical single-port laparoscopy. Key words: Transvaginal; Natural orifice transluminal endoscopic surgery; Myomectomy