Systematic Review and Meta-Analysis on Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Compared to Laparoscopic Hysterectomy for Benign Indications.

Susanne Housmans,Jan Deprest,Laura Cattani,Nargis Noori,Jan J A Bosteels,Supuni Kapurubandara,Ibrahim Alkatout,Jan Baekelandt

doi:10.3390/jcm9123959

Abstract

(1) Objective: We aimed to report an update of the systematic review and meta-analysis by Baekelandt et al. (2016). (2) Method: We followed PRISMA guidelines to perform this systematic review. We searched MEDLINE, EMBASE, CENTRAL and additional sources and aimed to retrieve randomised controlled trials (RCTs), controlled clinical trials (CCTs) and prospective/retrospective cohort studies in human subjects that allowed direct comparison of vNOTES to laparoscopy. (3) Results: Our search yielded one RCT and five retrospective cohort trials. Pooled analysis of two subgroups showed that, compared to conventional laparoscopy, vNOTES is equally effective to successfully remove the uterus in individuals meeting the inclusion criteria. vNOTES had significantly lower values for operation time, length of stay and estimated blood loss. There was no significant difference in intra- and postoperative complications, readmission, pain scores at 24 h postoperative and change in hemoglobin (Hb) on day 1 postoperative.

Highlights

Background and RationaleIn natural orifice transluminal endoscopic surgery (NOTES), the natural orifices of the human body are used to access the abdominal cavity to perform surgery
Is vaginal natural orifice transluminal endoscopic surgery (vNOTES) effective as the laparoscopic approach for successfully removing the uterus without the need for conversion? The HALON trial [13] is an randomised controlled trials (RCTs) designed to answer this question as the primary outcome
The control groups varied in type of surgery (TLH, laparoscopy assisted vaginal hysterectomy (LAVH) or single port LAVH (SP-LAVH)) and the technique for the vNOTES approach is not standardised across different studies, we considered it useful to pool the data into a meta-analysis comparing the results of the RCT to those of the observational studies

Summary

Introduction

Background and RationaleIn natural orifice transluminal endoscopic surgery (NOTES), the natural orifices of the human body are used to access the abdominal cavity to perform surgery. Current evidence supports vaginal hysterectomy as superior to laparoscopic and abdominal routes due to the shorter operating time and shorter recovery time [4]; its clinical application can be restricted by poor visualisation and limited manipulation [5]. These restrictions might be overcome with vNOTES as it combines the advantages of vaginal and endoscopic surgery [6]. An earlier systematic review and meta-analysis by Baekelandt et al [2] assessed the effectiveness and safety of vNOTES hysterectomy for non-prolapsed uteri and benign gynecological disease compared to the conventional laparoscopic technique. As many publications including a randomised control trial have been published since, we aimed to update this systematic review

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