Abstract
<h3>Study Objective</h3> To evaluate the adoption of vNOTES at a large resident driven county hospital and determine if this approach could significantly increase rates of vaginal hysterectomy. <h3>Design</h3> All hysterectomies done on the benign gynecology resident service of the presenter were included. A period of 24 months preceding the introduction of vNOTES (VANH: vaginal assisted vNOTES hysterectomy) was compared to a period of 24 months following the introduction of VANH. <h3>Setting</h3> Large County hospital resident gynecology service. <h3>Patients or Participants</h3> All patients presenting for hysterectomy for a 4-year period. <h3>Interventions</h3> The residents on each service block were introduced to vNOTES (VANH) as a route of hysterectomy. Residents suggest the desired route of surgery for each case, with faculty guidance as to relative and absolute contraindications for the planned route. In the early cohort, routes of hysterectomy were TVH, TLH, RA-TLH, and TAH. In the post intervention cohort, the routes of hysterectomy were TVH, VANH, TLH, RA-TLH, and TAH. <h3>Measurements and Main Results</h3> The main metric was the percentage of cases completed by each route, especially the percentage of cases completed vaginally, comparing TVH to TVH+VANH. An expansion in access to the daVinci Xi system resulted in an increase in the percentage of RA-TLH, so for the purposes of this analysis, these routes were considered together. Secondary considerations were conversion from planned route or complications. There were no conversions in the TVH or VANH category. Complications were correlated more with uterine size than planned route. <h3>Conclusion</h3> The addition of VANH to gynecological education can improve the access of residents to vaginal hysterectomies. By reducing perceived barriers to vaginal hysterectomy, it increases the number of patients considered candidates for vaginal surgery without increasing complications rates.
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