Orifice Transluminal Endoscopic Surgery Hysterectomy Research Articles

Adoption of vaginally assisted natural orifice transluminal endoscopic surgery for hysterectomy: A single tertiary experience.

Vaginal hysterectomy (VH) rate is declining despite being considered as the optimal minimally invasive option for hysterectomy with reduced operative time and length of stay compared with laparoscopic hysterectomy (LH). Vaginal assisted natural orifice transluminal endoscopic surgery hysterectomy (VANH) combines the advantages of both vaginal and endoscopic approach to surgery. To report feasibility and early experience of a single surgeon adopting VANH at a tertiary Australian hospital. Prospective review of the first 20 VANH cases with complete data set collected retrospectively including patient demographics, indication for surgery and perioperative outcomes. The median age of the first 20 participants was 51.5 years (47-57 years of age) and the median body mass index was 33.5 kg/m2 (27.8-38.3 kg/m2). The predominant indication was complex hyperplasia with atypia (12/20, 60%). The median parity was two (1-3) where four patients were nulliparous. The median blood loss was 125 mL (100-200 mL) with an operative time of 149 min (138-198 min) and median weight of the specimen of 181.5 g (66.5-219 g). The mean length of stay was 1.4 days (1-2 days). Five cases had conversion to laparoscopy and the majority (80%) occurred within the first ten cases. VANH is feasible but there is a learning curve to achieve competence in this technique, which requires adequate training in the early stages of adoption with careful case selection. Until further robust data is available to determine the clinical benefit and safety profile of VANH, patients should be carefully counselled and the decision on mode of hysterectomy be individualised.

Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Deconstructed: Expanding Minimally Invasive Gynecologic Surgeons' Toolbox.

The introduction of vaginal natural orifice transluminal endoscopic surgery (vNOTES) to the toolbox of gynecologic surgeons has the potential to reverse the trend of vaginal hysterectomy declines. This review discusses nuances of the vNOTES technique applied to hysterectomy; describes vNOTES hysterectomy, step-by-step (including tips and tricks for low- and high-complexity cases for surgeons who may want to incorporate vNOTES hysterectomy into their surgical repertoires); and examines evidence and research trends in this field. The descriptions in the text, figures, tables, and videos all contribute to giving readers a clear understanding of vNOTES, its advantages, limitations, and research potentials. vNOTES hysterectomy is a unique blend of vaginal, laparoscopic, and laparoendoscopic single-site surgery (LESS) techniques and is not a new procedure, but rather another tool to use in minimally invasive gynecologic surgery. (J GYNECOL SURG 40:78).

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.

Comparison of Hysterectomy and Bilateral Adnexectomy Performed via Laparoscopy or vNOTES: A Retrospective Cohort Study of 390 Patients

Background: This research aims to evaluate the clinical outcomes of vaginal natural orifice transluminal endoscopic surgery hysterectomy (vNOTESH) compared with conventional laparoscopic hysterectomy (cLH) on non-prolapsed uteri for presumed benign gynecologic disorders. Methods: We retrospectively analyzed the data of all patients receiving vNOTESH or cLH in Meizhou People’s Hospital, Meizhou, China from January 2018 and December 2020. Relevant patient characteristics and clinical outcomes data were collected after written informed consent. Results: There were no significant differences between cLH and vNOTESH groups regarding age, body mass index (BMI), number of pregnancy, history of abdominal operation, type of surgery, blood loss, changes in hemoglobin levels, postoperative fever, complications, 12th-hour, and 48th-hour Visual Analog Scale (VAS) scores. The vNOTESH group had significantly shorter operative time (67.37 ± 25.90 vs. 89.71 ± 36.43 min, p < 0.001) and postoperative hospitalization (5.25 ± 1.67 vs. 5.82 ± 2.88 d, p = 0.007) than the cLH group. Besides, the 24th-hour VAS scores were noticeably lower (1.50 ± 0.75 vs. 1.78 ± 0.77, p = 0.001) in the vNOTESH group. Furthermore, the subgroup analysis showed similar trend in operative time (83.56 ± 33.37 vs. 95.84 ± 33.83 min, p = 0.017) and 24th-hour VAS scores (1.38 ± 0.59 vs. 1.79 ± 0.75 min, p = 0.001) between the two enlarged uterine subgroups. Conclusions: The vNOTESH can offer a safe and effective alternative to laparoscopy for women with non-prolapsed benign uteri. Even in case with a large uterus, the vNOTESH can be a feasible treatment with promising short-term efficacy and safety as compared with cLH.

Cumulative Sum Analysis of Learning Curve Process for Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy

This study aimed to evaluate the learning curve of vaginal natural orifice transuminal endoscopic surgery (vNOTES) hysterectomy in expert minimal invasive and vaginal surgery team. This is a cohort study on a retrospective analysis. Department of Obstetrics and Gynecology of Cannizzaro Hospital in Catania Italy. First 50 women underwent vNOTES hysterectomy between February 2021 and February 2022. vNOTES hysterectomy performed by a team with optimal skills in laparoscopic and vaginal surgery. Primary outcome was surgical time. Secondary outcomes were intraoperative and postoperative complications, length of hospitalization, and first 24-hour postoperative pain. All patients underwent hysterectomy for benign indications: 27 fibromatosis, 13 metrorrhagia, and 10 precancerous. Concomitant procedures have been bilateral adnexectomy in 35 cases and bilateral salpingectomy in 15 cases. The median age was 51 years (range, 42-64). Median body mass index was 26 kg/m2 (range, 21-42). The median operative time was 75 minutes (range, 40-110). The median hospital stay was 2 days (range, 1-4). There was 1 intraoperative adverse event (bladder lesion) and 1 postoperative grade 3 complication (hemoperitoneum). The median visual analog scale score for pain assessment during the first 24 hours after surgery was 3 (range, 1-6). The experience in our surgical center with the first 25 vNOTES hysterectomies showed an accumulation of initial experience in the first 5 cases with stable operating time and a gradual reduction of mean operating time in the subsequent 17 surgeries. The learning curve plotted by cumulative sum analysis shows 3 phases: phase 1 of competence (cases 1-5), phase 2 of proficiency (cases 6-26), and phase 3 of mastering the procedure (after the 31st case) with the management of more complex cases. vNOTES hysterectomy is a feasible and reproducible approach for benign indications with a short learning curve and low rate of perioperative complications. For a team skilled in minimally invasive surgery, 5 cases are required to rich competence and 25 to rich proficiency in vNOTES hysterectomy. Mastering phase, with the introduction of more complex cases, should be addressed after 30 surgeries.

Robotic Natural Orifice Transluminal Endoscopic Surgery Hysterectomy and Salpingo-Oophorectomy in a Porcine Model.

Purpose. The emergence of robotic-assisted surgical techniques has gained significant indications in terms of reduced trauma, shortened recovery, and higher patients' satisfaction. However, limitations by present surgical robotic systems used in natural orifice transluminal endoscopic surgery (NOTES) gynecology still exists, such as arm collisions, countertraction, instrument dexterity, and, in particular, space confinement due to the narrow pelvic anatomy. The current study evaluated the use of a miniaturized single-site surgical robotic system and its feasibility in performing robotic NOTES gynecological procedures using a live porcine animal model. Methods. Using a transrectal approach, the fully internalized robotic arms were deployed in a reverse configuration to access the lower pelvic cavity of the animals to perform NOTES gynecological procedures. Results. Robotic-assisted transrectal gynecological procedures were successfully performed using the new robotic system. A hemi-hysterectomy with unilateral salpingo-oophorectomy was completed in the first animal and a total hysterectomy with bilateral salpingo-oophorectomy in the second animal with an average docking time of 22.5minutes and console time of 63minutes and 58minutes, respectively. The overall blood loss for each procedure was estimated to be <20mL per animal with no intraoperative complications. Conclusions. The reverse configuration of the miniaturized surgical robotic system has demonstrated its capability to provide a potential solution to maintain clear visualization of the surgical field, optimal triangulation, and dexterity robotic NOTES gynecological procedures within the deep confined space of the pelvic cavity.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy (VNOTES): A Walkthrough

Video Objective To present a thorough yet concise explanation of the methodology for the completion of a successful transvaginal hysterectomy via natural orifice transluminal endoscopic surgery. Design A narrated instructional video guide detailing each procedure (Canadian Task Force Classification III). Setting University Hospital, Baylor College of Medicine, Houston, Texas Patients Our patient is a 46-year-old G2P1011 who had two notable previous surgeries: a tubal ligation and an adnexa removal surgery. She possessed a narrow vagina and non-descent uterus while having a strong preference for maintaining a high level of cosmesis. Interventions A complete transvaginal hysterectomy utilizing solely natural orifice transluminal endoscopic surgery was performed on the patient. Transvaginal entry was established and with the gelpoint mini port in place we began circumferential dissection of the cervix anteriorly at the bladder fold. Utilizing the laparoscopic single tooth tenaculum, we hooked the anterior lip of the cervix for countertraction and hydro dissected the anterior cervix with 20 units of Vasopressin (Pitressin) in 20 ml of saline. Next, the monopolar hook was employed to cut the anterior colpotomy and begin the circumferential incision around the cervix. Following this, we used the LigaSure bipolar forceps to sever bilateral ureteral sacral ligament. The same strategy is used at the anterior cervix to separate the bladder from the uterus. Following bladder mobilization, the cardinal ligaments and uterine arteries were cauterized and transected by LigaSure. The right fallopian tube was removed utilizing the LigaSure first, before proceeding with the left fallopian tube; the pelvis was inspected with hemostasis noted throughout. Finally, the vaginal cuff was closed in traditional vaginal fashion after the deflation of the abdomen. Conclusion Despite certain drawbacks, utilizing pure natural orifice transluminal endoscopic surgery in hysterectomy is a safe and feasible procedure that maintains a high-level of cosmesis for patients while still offering the most minimally invasive route.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Aided by Transcervical Instrumental Uterine Manipulation

Study ObjectiveTo describe the technique of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy with the aid of transcervical instrumental uterine manipulation. DesignVideo with step by step description of technique. SettingMinimally Invasive Gynaecological Surgery Department, Naval Multi Speciality Hospital, Jalgaon, India. PatientA 47-year-old woman. InterventionvNOTES hysterectomy. Measurements and Main ResultsA 47-year-old patient presented with history of menorrhagia since 4 years as well as a history of failed medical management for menorrhagia. Ultrasonography showed an enlarged uterus with findings suggestive of adenomyosis. Body mass index of the patient was 27. She had a history of 2 normal vaginal deliveries and had undergone laparoscopic tubal sterilization in the past. During vNOTES hysterectomy, an instrument was placed transcervically into the uterus for manipulation, providing leverage that helped gain good exposure of all uterine attachments. It also prevented unintentional rotation of uterus and its attachments. Therefore, the surgeon did not need to use a second hand for retraction of the uterus during surgery, allowing that second hand for retraction of bowel and adnexa. Hysterectomy was completed without any complications. Total estimated blood loss was 55 mL, and the patient was discharged on the third day. ConclusionBecause the tip of instrument is not completely visible in vNOTES surgery, manipulation helps to deflect the uterus and its attachments away from important structures, thus preventing inadvertent thermal damage from the tip of the instrument. This is a feasible and safe technique for vNOTES hysterectomy.

The outcomes of transvaginal NOTES hysterectomy in various uterine sizes

ObjectivesNatural orifice transluminal endoscopic surgery (NOTES) is an emerging technique in the area of minimally invasive procedures. Preliminary reports have confirmed transvaginal NOTES to be a safe and feasible method for performing hysterectomy and adnexal procedures. However, there are limitations regarding the feasibility of performing transvaginal NOTES hysterectomy in various uterine sizes. Materials and methodsTwo hundred and seventy-five women who had undergone transvaginal NOTES hysterectomy for benign pelvic lesions were recruited from May 2012 to May 2016. Their medical records were retrospectively reviewed. All patients were placed into one of three groups depending on weight of the surgical specimen in order to assess surgical outcomes. ResultsOne hundred ninety-one patients (69.46%) had a uterine weight of <500 g (group 1), 67 (24.36%) had a uterine weight of 500–999 g. (group 2), and 17 (6.18%) had a uterine weight of ≥1000 g. (group 3). The mean age± SD of group 1, group 2, and group 3 were 48.68 ± 6.63, 47.22 ± 3.81, and 46.53 ± 2.96 years, respectively (p value = 0.110). There was no statistical differences in terms of parity, body mass index (BMI), or history of abdominal surgery among the three groups. With regard to surgical outcomes, the mean operative times (Standard error: SE) were 76.70 (0.68), 99.99 (1.14), and 152.88 (3.37) minutes in Group 1, Group 2, and Group 3, respectively. The mean amounts of blood loss (SE) was 180.85 (4.61), 342.57 (6.98), and 532.35 (11.85) ml in Group 1, 2, and 3, respectively. There were statistically significant differences in terms of operative time and blood loss among the three groups (p = 0.0001 and 0.0001, respectively). ConclusionsAlthough the size of uterus has a significant effect on operative time and blood loss, NOTES hysterectomy can be successfully performed without any increase in complication rates. Natural orifice transluminal endoscopic surgery hysterectomy is a safe and feasible procedure even in large uteri.

Minimally invasive hysterectomy for benign indications: an update.

Hysterectomy is one of the most commonly performed surgeries worldwide. Indication for hysterectomy is most often benign, which includes conditions such as prolapse, abnormal uterine bleeding, fibroids and pelvic pain. A broad range of surgical approaches exists for hysterectomy, ranging from open to minimally invasive techniques. Under this minimally invasive umbrella, the following techniques are included: vaginal hysterectomy, laparoscopic hysterectomy, and variations of those two techniques, such as laparoscopic-assisted vaginal hysterectomy, robotic-assisted hysterectomy, laparo-endoscopic single-site laparoscopic hysterectomy, mini-laparoscopic hysterectomy, and natural orifice transluminal endoscopic surgery hysterectomy. As hysterectomy is being performed increasingly via a minimally invasive route, it is important that gynecologists are familiar with the established as well as emerging techniques for minimally invasive hysterectomy (MIH). Surgical planning is a complex process, which requires an in depth and informed conversation between a patient and her physician. Patient preferences, surgeon skill and indication for surgery all should be taken into consideration when determining the most appropriate surgical approach. This article will review the different routes of MIH. Perioperative considerations will be discussed, as will the advantages and disadvantages of each minimally invasive approach.