Transvaginal natural orifice endoscopic surgery for hysterectomy: a prospective cohort study

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its advantages, including reduced postoperative pain and the absence of visible scarring. However, the anatomical specificity required for vNOTES may increase the risk of injury to nearby organs, such as the rectum and bladder. This study aims to evaluate the safety and potential benefits of vNOTES compared to transumbilical laparoendoscopic single-site surgery (LESS) for Hysterectomy.

The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), conducted in Chengdu, China, included 192 patients who underwent hysterectomy between May and October 2023. This study prospectively collected and compared perioperative and follow-up data between the two groups.

The vNOTES group demonstrated shorter surgery times, postoperative flatus time, and hospital stays, but it also had a higher conversion rate. Specifically, the vNOTES approach reduced surgery duration by approximately 29.8 min (95% CI: -41.31, -18.34, P < 0.001) but increased intraoperative blood loss by about 41.82 mL (95% CI: 25.81, 57.82, P < 0.001).

By combining laparoscopy with traditional vaginal surgery, vNOTES offers advantages such as shorter surgery times, faster postoperative recovery, reduced hospital stays, greater minimal invasiveness, and improved cosmetic outcomes. However, it is essential for surgeons to continually enhance and standardize preoperative assessments and surgical techniques to minimize conversion rates and reduce intraoperative blood loss.

ChiCTR2200059282, China Clinical Trials Registry, April 28, 2022.