Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery vs laparoscopic hysterectomy

Abstract

ObjectiveAs vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic hysterectomy techniques both aim to decrease tissue injury, decrease postoperative morbidity and mortality, and improve patient's quality of life, we sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional laparoscopic hysterectomy in women with benign gynecologic diseases. Data SourcesWe used Scopus, Medline, ClinicalTrials.Gov, PubMed, and the Cochrane Library, searching from inception until September 1st 2023. Study Eligibility CriteriaWe included all eligible articles that compared vNOTES hysterectomy to any conventional laparoscopic hysterectomy technique without robotic assistance for women with benign gynecologic pathology, and included at least one of our main outcomes. These outcomes included estimated blood loss (in ml), operation time (in minutes), length of hospital stay (in days), decrease in hemoglobin level (g/dL), visual analog scale (VAS) pain score on postoperative day one, opioid analgesic dose required, rate of conversion to another surgical technique, intraoperative complications, postoperative complications, and requirements of blood transfusion. We included RCTs as well as observational studies. Ultimately 14 studies met our criteria. Study Appraisal and Synthesis MethodsStudy quality of the RCTs was assessed using the Cochrane assessment tool, and the quality of the observational studies was assessed using the ROBINS-I tool. We analyzed data using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. Dichotomous outcomes were analyzed using OpenMeta[Analyst] with odds ratios (OR) and 95% CIs. ResultsOperative time and the length of hospitalization were shorter in the vNOTES cohort. We also found lower VAS scores, fewer postoperative complications and fewer blood transfusions in the vNOTES group. We found no difference in estimated blood loss, decrease in hemoglobin levels, analgesic usage, conversion rates or intraoperative complications. ConclusionsWhen in including the latest data, vNOTES techniques may have some advantages over conventional laparoscopic hysterectomy techniques.