Large Uterus Research Articles

Uterine Artery Embolization to Facilitate Minimally Invasive Hysterectomy for Very Large Fibroid Uteri

Uterine Artery Embolization to Facilitate Minimally Invasive Hysterectomy for Very Large Fibroid Uteri

VNOTEsHC : Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopic for large uteri: study protocol for a multicentre randomised controlled trial.

In France, 62,000 hysterectomies are performed per year, 70% of which are benign. The choice of approach (laparotomy, laparoscopy or vaginal route) is particularly important in the case of large uterus (> 280g) which are associated with a higher risk of complications. The current data are not sufficient to favour one or other approach. A new medical device, the vNOTES (Natural Vaginal Orifice Transluminal Endoscopy System), offers the advantage of both laparoscopic and vaginal route for pelvic surgery. To demonstrate the superiority in terms of intraoperative and postoperative complications of the use of a natural orifice transluminal endoscopic hysterectomy system (vNOTES) versus laparoscopic hysterectomy for benign pathologies on estimated large volume uteri (>280g). A randomised, double-blind, superiority trial will be performed at five hospital centres. Women with benign uterine pathology requiring hysterectomy and with a large uterus (> 280g) will be randomised to receive either laparoscopic or vNOTES hysterectomy. The primary outcome will be the occurrence of intraoperative and postoperative complications within 6 weeks of surgery. Secondary outcomes will be conversion during surgery, duration of surgery and hospitalisation, postoperative pain, postoperative complications, resumption of sexual life and satisfaction with the surgical team. 248 women will be randomised. This trial will provide a better understanding of the approach to large uteri optimise the care of these thousands of women undergoing hysterectomy. This trial will evaluate the vNotes for large uteri.

Obvious advantage of vaginal natural orifice transluminal endoscopic surgery hysterectomy against total laparoscopic hysterectomy in small uterus patients and the future prospects at a regional core institution: A retrospective study.

Owing to the combination of benefits, including permanent visual guidance and no abdominal skin incision, vaginal natural orifice transluminal endoscopic surgery hysterectomy (vNOTES-H) is currently widely used. However, the introduction of vNOTES-H has been delayed in many Japanese regional core hospitals because of its specific device and skill requirements. Therefore, the characteristics and advantages should be explained for the widespread use of this technique. We reviewed the medical records of 17 patients with vNOTES-H and 94 patients with total laparoscopic hysterectomy (TLH) from January 1, 2015 to December 31, 2022. In this analysis, to compare the results of vNOTES-H to TLH, we excluded certain patients with a relatively heavy uterus (>255g) and the presence of abdominal adhesions. In this report, first, the characteristics of the vNOTES-H procedures using a transvaginal access platform are explained by referring to one representative patient. Second, the patient characteristics of the vNOTES-H and TLH groups, including operation time and blood loss amount, were compared. Then, to detect the influence of vNOTES-H on the difficulty of operation among all 111 patients, we performed a multivariate logistic regression analysis to assess the influence of each of 9 factors, including "vNOTES-H", "Advanced age", "High BMI", "3 parity", "Gynaecological operation history", "Adenomyoma", "Large leiomyoma", "Heavy uterus" and "Large uterus", on the two indexes, including "Short time operation" and "Massive blood loss". In the simple comparison between the groups with vNOTES-H and TLH, the operation time in the former group was significantly shorter than in the latter group, although other factors did not show significant differences, including blood loss amount. Moreover, in the multivariate logistic regression analysis of all 111 patients, the "vNOTES-H" factor showed a significantly high possibility of "short time operation", although no factor, including "vNOTES-H", showed a significant influence on "massive blood loss". vNOTES-H showed advantages in terms of operation time without increasing blood loss for patients with a relatively small uterus. However, to expand the selection for vNOTES-H, we should accumulate further patients and perform more analyses.

Herlyn-Werner-Wunderlichov sindrom s piohematokolposom

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare malformation syndrome of the women reproductive tract characterized by uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis. We report here a case of a 20 year-old patient presented to the emergency department with pain in the right lower quadrant. The clinical exam showed a vaginal fluctuant painful mass obliterating the right part of the vagina. Transvaginal ultrasound showed uterus didelphys, the right uterus was dilated with a dense fluid collection which corresponded to pyohematometra. It also revealed a dense vaginal collection which corresponded to pyohematocolpos. Abdominal ultrasound showed the absence of a right kidney. The laparoscopy showed uterus didelphys with a large right uterus. We performed the resection of the vaginal septum to reconstruct one vagina. The first follow-up visit revealed a healthy wound with no adhesion of the vaginal wall. Prompt and accurate diagnosis of female reproductive tract disorders, including HWWS, is necessary to prevent complications and preserve future fertility.

Comparison of surgical outcomes between robot-assisted and conventional laparoscopic hysterectomy for large uterus.

We compared the effectiveness of conventional total laparoscopic hysterectomy (TLH) against robot-assisted total hysterectomy (RAH) in patients with a large uterus. According to the subtype of minimally invasive hysterectomy performed for benign indications, the patients (n = 843) were grouped as follows: TLH (n = 340) and RAH (n = 503). The median operative time (OT) for TLH was 98min (47-406min), and the estimated blood loss (EBL) was 50mL (5-1800mL). The median OT for RAH was 90min (43-251min), and the EBL was 5mL (5-850mL), with a significantly shorter OT and a lower EBL in RAH than in TLH. Uterine weight was categorized into four groups in increments of 250g. The number of cases in each group was 163 (< 250g), 116 (250-500g), 41 (500-750g), and 20 (≥ 750g) for TLH, and 308 (< 250g), 137 (250-500g), 33 (500-750g), and 25 (≥ 750g) for RAH. In patients with a uterus < 250g, there was no significant difference in OT between TLH and RAH, but in patients with a uterus ≥ 250g, OT tended to be shorter with RAH, which was also true for a uterus ≥ 750g. The EBL was significantly lower with RAH compared to TLH, regardless of uterine weight. In patients with a large uterus, the advantages of robotic surgery can be utilized, which may lead to a shorter OT and less EBL.

Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri

Our study aimed to compare conventional laparoscopic hysterectomies (LHs) with vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies performed for patients with large uteri (weight >280 g) at our institution, which underwent a change in practice from conventional LH to vNOTES for large uteri. Retrospective cohort. French tertiary university hospital. Two cohorts: the last 54 patients who underwent vNOTES hysterectomy and the last 52 patients who underwent conventional LH for large uteri. Baseline characteristics and surgical outcomes were assessed, including uterine weight, mode of delivery for previous pregnancies, history of abdominal surgery, indication for hysterectomy, associated procedures, operative time (OT), complications, volume of intraoperative bleeding, and length of postoperative hospital stay. Both groups were comparable, with a mean uterine weight of 586.4 ± 289.2 g in the laparoscopy group compared with 686.7 ± 374.6 g in the vNOTES group. There was a significant decrease in the OT in the vNOTES group with a median of 99 minutes (66.5-138.5 minutes) compared with 171 minutes (131-208 minutes) in the laparoscopy group, p <.001. The length of hospital stay was also decreased in the vNOTES group with a median of 0.5 nights compared with 2 nights in the laparoscopy group, p <.001. More patients were managed in an ambulatory setting in the vNOTES group (50% vs 3.7%, p <.001). Our study did not find any significant difference in terms of bleeding or the number of conversions to another surgical approach. The frequency of intraoperative and postoperative complications was very low. Compared with the laparoscopic approach, vNOTES hysterectomy for large uteri (>280 g) is associated with decreased OT, a shorter hospital stay, and increased performance in the ambulatory setting.

Abnormal Uterine Bleeding in Women&lt;40 Years and Its Risk Factors

Background: Abnormal uterine bleeding (AUB) is a common cause for outpatient and emergency department visits in reproductive-aged women and may have a significant impact on quality of life. Objective: The study aimed to determine the clinical risk factors for abnormal uterine bleeding in women &lt;40 years age. Methods: This was a cross-sectional study conducted in the Obstetric &amp; gynae department in Khwaja Yunus Ali medical college and hospital from January 2021 to December 2021. Clinical information was retrieved retrospectively from the patients' medical records. Results: 120 women of reproductive age with abnormal uterine bleeding participated in the study. Most of them were in the 36-40 age group. The patients' average age was 34.28 years. 88 (73.33%) had a large uterus, and 86 (70%) had atypical menstruation histories. Clinical symptoms included 35 (29.17%) heavy periods, 28 (23.33%) metrorrhagia, 22 (18.33%) polymenorrhea, 17 (14.17%) oligomenorrhea, 6 (5%) amenorrhea, and 12 (10%) reported symptoms of intermenstrual bleeding. After reviewing the medical records, it was discovered that 33 (27.5%) had diabetes, 37 (30.83%) had hypertension, 16 (13.33%) had both diabetes and hypertension, 7(5.63%) had hypothyroidism, 5 (4.17%) had cancer, 19(15.83%) were obese, and the majority of the patients, 87 (72.5%) were anemic. Multiple pregnancy was also a significant factors for AUB. Conclusion: AUB can be caused by factors such as increased age, obesity, nulliparity, irregular menstrual cycles, a history of diabetes, hypertension, and more. The only risk factor in the present study that was statistically significant was irregular menstruation history. Bulky uterus, multiple pregnancies, and irregular menstrual cycles may be related with abnormal uterine bleeding.

Robotic vNOTES Techniques for Hysterectomy in a Patient with a 16-week Sized Uterus and a Body Mass Index of 70

To demonstrate the surgical techniques for robotic vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) in a World Health Organization class 3 obesity patient (body mass index=70) as well as large fibroid uterus (16 weeks sized). Stepwise demonstration with narrated video footage. An academic tertiary care hospital. Our patient is a 50-year-old G0 with postmenopausal vaginal bleeding with an enlarged uterus; her endometrial biopsy showed complex endometrial hyperplasia with atypia. The surgical exposure for extremely obese patients with a concomitantly large uterus can be very challenging transabdominally due to the patient being unable to tolerate the Trendelenburg position and abdominal gas pressure [1-5]. Therefore, transvaginal NOTES can be an alternative option for these types of challenging patients. However, although there are clear benefits of vNOTES surgery in obese patients, we still need to be thoughtful and deliberate in handling this kind of surgery [6]. Several key success factors that aid in the completion of the surgery include 1. Appropriate patient positioning (Trenguard Position) as tolerated. 2. Initial vaginal section of hysterectomy. 3. Successful port placement. 4. Trendelenburg, as far as tolerated. 5. Harnessing the robotic camera for anterior colpotomy. 6. Utilizing alternative surgical exposure techniques: air seal for maintaining gas pressure for optimizing exposure, lap pad for thermal isolation, and maintaining the uterus for safe exposure during BSO. 7. After identification of the bilateral ureters, the broad, round, and uterine ovarian ligaments were transected with vessel sealer (less thermal spread), and the cystectomy was completed. (Supplemental Video 1) 8. BSO was completed. 9. In-bag uterine tissue extraction. 10. Vaginal cuff closure with V-Loc barbed suture. Robotic-assisted NOTES hysterectomy with BSO is feasible and safe in extremely obese patients with large uterus. The combination of all these strategies could aid in the feasibility and safety of patients with these challenging pathology and morbidity.

Validation of uterine artery embolization before surgical laparoscopic myomenucleation compared to single surgical laparoscopic myomenucleation for the treatment of large fibroids and uterus myomatosus.

To determine the efficacy of preoperative uterine artery embolization (uterine artery embolization; UAE) prior to elective laparoscopic fibroid removal compared to single laparoscopic fibroid removal in women with large uterine fibroids and women with uterus myomatosus. A total of 202 women with symptomatic uterine fibroids who were scheduled for elective fibroid enucleation were included in this retrospective, monocentric, non-randomized study. Two procedures were compared: women who received percutaneous UAE 24 h prior to elective laparoscopic fibroid eviction for large uterine fibroids (>6 cm) and uterus myomatosus. And women who received laparoscopic fibroid enucleation alone for large uterine fibroids and uterus myomatosus. Outcome parameters for effectiveness were the hospital stay, the operating time and the intraoperative blood loss. Women who underwent preoperative percutaneous embolization of the uterine arteries, both for large fibroids and uterus myomatosus, had significantly less blood loss, shorter hospital stays, and shorter operating times. Especially women with large uterine fibroids and women with uterus myomatosus after having children can benefit from the combination therapy of preoperative percutaneous uterine embolization with subsequent laparoscopic myoma enucleation.

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends and Perioperative Complications from 2007 to 2018 Using the NSQIP Database

Study ObjectiveTo examine national trends among race and ethnicity and route of benign hysterectomy from 2007 to 2018. DesignThis is a retrospective analysis of the prospective National Surgical Quality Improvement Program cohort program. SettingThis study included data from the National Surgical Quality Improvement Program database including data from the 2014 to 2018 targeted hysterectomy files. PatientsAdult patients undergoing hysterectomy. InterventionsNone Measurements and Main ResultsCurrent Procedural Terminology codes identified women undergoing benign hysterectomy and perioperative data including race and ethnicity were obtained. To determine relative trends in hysterectomy among race and ethnicity cohorts (White, Black, Hispanic), we calculated the proportion of each procedure performed annually within each race and ethnicity group and compared it across groups. From 2007 to 2018, 269 794 hysterectomies were collected (190 154 White, 45 756 Black, and 33 884 Hispanic). From 2007 to 2018, rates of laparoscopic hysterectomy increased in all cohorts (30.2%–71.6% for White, 23.9%–58.5% for Black, 19.9%–64.0% for Hispanic; ptrend <0.01 for all). For each year from 2007 to 2018, the proportion of women undergoing open abdominal hysterectomy remained twice as high in Black Women compared with White women (33.1%–14.4%, p <.01). Data from the 2014 to 2018 targeted files showed Black and Hispanic women undergoing benign hysterectomy were generally younger, had larger uteri, were more likely to be current smokers, have diabetes and/or hypertension, have higher body mass index, and have undergone previous pelvic surgery (p ≤.01 for all). ConclusionCompared with White women, Black and Hispanic women are less likely to undergo benign hysterectomy via a minimally invasive approach. Although larger uteri and comorbid conditions may attribute to higher rates of open abdominal hysterectomy, the higher prevalence of abdominal hysterectomy among younger Black and Hispanic women highlights potential racial disparities in women's health and access to care.

Risk of Recurrence and Reintervention After Uterine-Sparing Interventions for Symptomatic Adenomyosis: A Systematic Review and Meta-Analysis.

To evaluate the risk of recurrence and reintervention after uterine-sparing treatment options for symptomatic adenomyosis, including adenomyomectomy, uterine artery embolization (UAE), and image-guided thermal ablation. We searched electronic databases such as Web of Science, MEDLINE, Cochrane Library, EMBASE, ClinicalTrials.gov , and Google Scholar from January 2000 to January 2022. The search was conducted using the following search terms: "adenomyosis," "recurrence," "reintervention," "relapse," and "recur." All studies that described the risk of recurrence or reintervention after uterine-sparing interventions for symptomatic adenomyosis were reviewed and screened according to the eligibility criteria. Recurrence was defined as the reappearance of symptoms (painful menses or heavy menstrual bleeding) after significant or complete remission, or the reappearance of adenomyotic lesions confirmed by ultrasonography or magnetic resonance imaging. The outcome measures were presented as the frequency with percentage and pooled with 95% CI. A total of 42 studies (single-arm retrospective and prospective studies) that represented 5,877 patients were included. The recurrence rates after adenomyomectomy, UAE, and image-guided thermal ablation were 12.6% (95% CI 8.9-16.4%), 29.5% (95% CI 17.4-41.5%), and 10.0% (95% CI 5.6-14.4%), respectively. The reintervention rates were 2.6% (95% CI 0.9-4.3%), 12.8% (95% CI 7.2-18.4%), and 8.2% (95% CI 4.6-11.9%) after adenomyomectomy, UAE, and image-guided thermal ablation, respectively. Subgroup analysis and sensitivity analysis were performed, and the heterogeneity was reduced in several analyses. Uterine-sparing techniques were successful in treating adenomyosis with low reintervention rates. Uterine artery embolization had higher recurrence and reintervention rates than other techniques; however, patients treated with UAE had larger uteri and larger adenomyosis, indicating that selection bias may influence these results. More randomized controlled trials with a larger population are needed in the future. PROSPERO, CRD42021261289.

The revival of vaginal surgery in the era of endoscopy: V-NOTES initial experience with a series of 32 patients.

Transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) is an emerging surgical technique in the evolution of minimally invasive surgery. This technique allows different types of surgical procedures to be performed by vaginal access with endoscopic control. The combination of vaginal surgery and laparoscopy brings many advantages, especially the absence of incisions in the abdominal wall and better visualization of the abdominal cavity. In this retrospective study we report our initial experience of V-NOTES in benign gynaecologic surgery by describing our first consecutive 32 surgeries. From June 2020 to January 2022, 32 gynaecological procedures were performed by V-NOTES by the same surgeon in a university hospital. Perioperative outcomes were evaluated retrospectively. Conversion to laparoscopy or laparotomy and peri-operative and post-operative complications. None of the 32 V-NOTES procedures required conversion to conventional laparoscopy or laparotomy. We observed 2 intraoperative complications managed by V-NOTES and 2 post-operative complications (Clavien-Dindo Grade 2). Our results are similar to studies previously published about this subject and are promising concerning the techniques efficacy and safety. We do believe that a short training allows to reach benefits safely. However, further prospective multicentre randomized trials comparing V-NOTES to totally laparoscopic hysterectomy and to vaginal hysterectomy are needed to strengthen the validity of this new approach. V-NOTES widens the indications of vaginal hysterectomies by removing limitations such as large uterus, absence of prolapse, and history of caesarean. Moreover, this technique allows adnexal surgery to be performed by vaginal access.

A Vagino-Laparoscopic Strategy for Hysterectomy of Large Uteri to Ease Surgical Challenges.

To develop a vagino-laparoscopic strategy for hysterectomy (VLH) to treat uteri with large fibroids at ≥ 16 weeks of gestation to ease surgical challenges. This was an observational study conducted in our private general hospital on 64 consecutive cases involving uteri with large and benign fibroids at ≥ 16 weeks of gestation. We excluded cases with an associated ventro-fixed uterus and large cervical fibroids. The VLH strategy involves vaginal separation of the uterosacral with the uterine arteries followed by laparoscopic separation of the remaining upper pedicles. The uterus was then removed vaginally. The largest uteri receiving treatment was at 26 weeks of gestation and the mean uterus weight was 869.60 ± 275.10 g (range: 500-1900 g). The VLH strategy was successful in 63 (98.43%) cases irrespective of the configuration of the uterus. One case (1.56%) required mini-laparotomy conversion due to the need for adhesiolysis; this case exhibited extensive adhesion of the rectum to the posterior wall of the uterus due to a history of previous myomectomy of the posterior wall. There were no conversions due to failed laparoscopic exposure of the adnexal or uterine vascular pedicles, or due to uncontrolled intraoperative bleeding. There were no cases of urinary tract injury or other major complications. The vaginal detachment of uterosacral ligaments before the laparoscopic phase of the VLH strategy increased upwards mobility and dislodged the cervico-isthmic level of large uteri from the narrow lower aspect of the pelvis to the upper wider part of the pelvis; this eased the surgical challenges associated with such cases and avoided complications during laparoscopy. We developed a vagino-laparoscopic strategy for hysterectomy that can ease the technical challenges associated with the majority of large uteri.

Severe chronic pelvic pain due to cystic degeneration of subserosal uterine fibroid with type 2 diabetes and obesity: Serial case report.

Uterine fibroids, benign tumors of the myometrium, can cause pelvic pain. Obesity and diabetes mellitus can increase the risk of developing fibroid. We present two cases of uterine fibroid, diabetes mellitus, and obesity with moderate-to-severe chronic pain. The first case is a 37-year-old woman with pelvic pain and a subserosal uterine fibroid, primary infertility, grade 2 obesity, and diabetes mellitus. Pathologic examination revealed smooth muscle cells with degeneration sites. The second case is a 35-year-old nulliparous woman with abdominal enlargement, lower abdominal pain, diabetes mellitus, and morbid obesity. Ultrasonography showed a large uterus with a hyperechoic mass and cystic degeneration. Histopathological examination revealed leiomyoma. Our patient's chronic pelvic pain may be caused by its large size. Excess adipose tissue in obesity may result in the formation of estrone, causing the proliferation of fibroids. A subserous fibroid is less likely to cause infertility; thus, a myomectomy was performed to relieve pain. Obesity and diabetes could interfere with patients' periods. Higher levels of insulin and fat tissue induce androgen production. Increased estrogen levels lead to alteration of gonadotropin production, menstrual abnormalities, and ovulatory dysfunction. Cystic degeneration of the subserous uterine fibroid could induce pain though it rarely affects fertility. A myomectomy was conducted to relieve pain. Comorbid diseases such as diabetes mellitus and obesity can lead to cystic degeneration of the uterine fibroid.

Widest Uterine Grip Width Measurement Clinically to Predict the Success of the Vaginal Hysterectomy of a Very Large Fibroid Uterus

To find a simple clinical method to predict the success of the vaginal hysterectomy (VH) in the case of a very large fibroid uterus.

Total Abdominal Hysterectomy for a 36 Weeks Size Fibroid Uterus through a Supra Pubic Transverse Incision

Introduction: Uterine fibroids are the commonest Gynecological benign tumor which affect reproductive age women. Surgical management of large fibroid uterus create multiple challenges to both surgeon and the patient. This is a cases of 36 weeks size fibroid uterus, grown up to the level of xiphisternum which treated with total abdominal hysterectomy through a suprapubic transverse incision. Case: 45-year-old, previously healthy multi-parous women presented with progressive abdominal distention for one to two years. Clinical and Ultrasound scan confirmed the fibroid uterus. She successfully underwent total abdominal hysterectomy through a supra-pubic transverse incision. Conclusion: Management of a fibroid uterus depends on patient’s age, fertility wishes, uterine preserving desires, symptomatology, site and size of the fibroids. Successful hysterectomy can be done through a supra-pubic transverse incision even for a 36 weeks size fibroid uterus in carefully selected cases.

Facilitating method for removal of the large uterus after laparoscopic hysterectomy: Vaginal vault vertical incision

BackgroundIn patients with a large uterus, an important part of the laparoscopic hysterectomy operation time is the phase of removing the uterus from the abdomen.The development of techniques that will shorten the morcellation time is the key to reducing the total operation time. AimTo evaluate the effect of vaginal cuff vertical incision in accelerating removal of the large uterus in laparoscopic hysterectomy. MethodsThis study was performed with patients who underwent total laparoscopic hysterectomy. In the study group, a vertical incision was performed in the middle of the posterior vaginal stump before the vaginal removal of the larger uterus (weighing more than 500 g). The control group consisted of patients who underwent vaginal morcellation after conventional colpotomy. Patients in both groups were matched in terms of uterine weights +/-50 g and the same vaginal morcellation technique was applied to all patients. ResultsIn patients who underwent a vertical incision procedure, the time to remove the uterus from the abdomen (17.55±2.53 min vs 26.62±4.72 min, p<0.001) and the total operation time (130.81±12.83 min vs.143.29±13, 15 min, p = 0.001) was statistically significantly less than the patients without vertical incision. There was no difference between the groups in terms of intraoperative complications, drop in hemoglobin levels, time to flatus, postoperative 6th,24th hour visual analog score and length of hospital stay. ConclusionsThe vertical incision procedure reduces the time to remove the large uterus from the abdomen after laparoscopic hysterectomy and, accordingly, the total operation time. This procedure may be the preferred method before vaginal morcellation, especially in large uterus.

The effect of uterine volume on surgical outcomes following uterine preserving apical prolapse repair

ObjectiveIn recent years uterine preservation has become a popular option in women undergoing pelvic organ prolapse repair. The aim of this study was to evaluate the effect of uterine volume on outcomes following uterine preserving surgical treatment for apical prolapse. MethodsWe performed a retrospective comparative study at a tertiary university hospital. Included were women who had uterine preserving surgical treatment for apical prolapse. The cohort was divided into two groups: 1) Patients with a uterine volume ≥ 35 cm3 (large uterus group); 2) Patients with uterine volume < 35 cm3 (small uterus group). Pre-, intra-, and post-operative data were compared between groups. Our primary outcome was composite outcome success including clinical and anatomical success and no need for reoperation. Secondary outcomes included clinical success, anatomical success, and patient satisfaction evaluated using the PGI-I questionnaire. ResultsEighty-four patients were included in the final analysis. The large uterus group (≥35 cm3) consisted of 37 patients as opposed to 47 in the small uterus group (<35 cm3). Clinical (91.9 % vs 87.1 %, p = 0.725) and anatomical success (84.8 % vs 90.9 %, p = 0.508) were high and did not differ between groups. Composite outcome success was 76.1 % in the small uterus group compared to 87.9 % in the large uterus group, but this difference was not statistically significant. Post-operative points Ba, C and Bp were similar between groups. No difference was found in patient satisfaction measured using the PGI-I questionnaire. ConclusionWomen undergoing uterine preserving apical prolapse repair with uterine volume ≥ 35 cm3 have comparable surgical outcomes to patients with a smaller uterus.

Comparison of Surgical Outcomes of Robotic versus Conventional Laparoscopic Hysterectomy of Large Uterus with Gynecologic Benign Disease.

Hysterectomy is commonly performed for benign gynecological diseases. Minimally invasive surgical approaches offer several advantages. Unfortunately, few studies have compared the outcomes of different types of minimally invasive surgeries. Therefore, this study aimed to compare the surgical outcomes of robotic hysterectomy (RH) and conventional laparoscopic hysterectomy (CLH) in benign gynecologic diseases. We performed a retrospective cohort study at a single center between January 2014 and July 2022. A total of 397 patients (RH: 197 and CLH: 200) who underwent minimally invasive hysterectomy for benign diseases with uterine size exceeding 250 g were enrolled, and factors related to the surgical outcomes were compared. The median age was 46 (range, 35-74) years, and the median uterine weight was 400 (range, 250-2720) g. There were no significant differences between the two groups regarding age, body mass index, uterine weight, hospital stay, estimated blood loss, or operating time. Intraoperative and postoperative complication rates were not significantly different between the two groups. RH was not inferior to CLH in terms of perioperative and immediate postoperative outcomes in our study.

Pure vNOTES Contained Power Morcellation: First Report

Study Objective To demonstrate a new technique of pure vaginal natural orifice transluminal endoscopic surgery (vNOTES) contained power morcellation of a transversely enlarged uterus in an endobag. Design Stepwise description of the technique with a narrated video. Setting Minimally invasive gynecological surgery department with experience in vNOTES at a tertiary care private hospital. Patients or Participants A 45-year-old female with a large fibroid uterus resulting in severe menorrhagia. Interventions The surgery is performed in the following manner and sequence- 1. Vaginally assisted NOTES hysterectomy for a large fibroid uterus. 2. Transvaginal insertion of VNMor Endobag (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India) and bagging the specimen. 3. Application of vNOTES port to the VNMor Endobag followed by power morcellation of large uterus in bag using the Versator NOTES morcellator (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India). Measurements and Main Results The duration of hysterectomy was 43 mins, the duration of power morcellation was 14.5 mins, and the duration of other steps was 17 mins. Blood loss was about 75 ml. The weight of the retrieved specimen was 906 grams. There was no conversion to laparoscopy or laparotomy. There were no intraoperative and postoperative complications. The patient was discharged on day 2. Conclusion Pure vNOTES contained power morcellation is a feasible new technique using new modified instrumentation. This technique can possibly reduce the time required for specimen retrieval through a narrow vagina. It has the potential to retrieve large uteri or masses transvaginally. However, this should be evaluated in further studies. To demonstrate a new technique of pure vaginal natural orifice transluminal endoscopic surgery (vNOTES) contained power morcellation of a transversely enlarged uterus in an endobag. Stepwise description of the technique with a narrated video. Minimally invasive gynecological surgery department with experience in vNOTES at a tertiary care private hospital. A 45-year-old female with a large fibroid uterus resulting in severe menorrhagia. The surgery is performed in the following manner and sequence- 1. Vaginally assisted NOTES hysterectomy for a large fibroid uterus. 2. Transvaginal insertion of VNMor Endobag (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India) and bagging the specimen. 3. Application of vNOTES port to the VNMor Endobag followed by power morcellation of large uterus in bag using the Versator NOTES morcellator (Veol Medical Technologies, Koparkhairane, Navi Mumbai- 400705, India). The duration of hysterectomy was 43 mins, the duration of power morcellation was 14.5 mins, and the duration of other steps was 17 mins. Blood loss was about 75 ml. The weight of the retrieved specimen was 906 grams. There was no conversion to laparoscopy or laparotomy. There were no intraoperative and postoperative complications. The patient was discharged on day 2. Pure vNOTES contained power morcellation is a feasible new technique using new modified instrumentation. This technique can possibly reduce the time required for specimen retrieval through a narrow vagina. It has the potential to retrieve large uteri or masses transvaginally. However, this should be evaluated in further studies.