Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study

OBJECTIVE: To compare vaginally-assisted natural orifices endoscopic transluminal endoscopic surgery (vNOTES) hysterectomy with salpingectomy/salpingo-oophorectomy with standard laparoscopic access. METHODS: Medical records for patients undergoing hysterectomy with adnexectomy for benign disease indication between February 1, 2019 and February 1, 2020 were retrospectively examined. Exclusion criteria were endometriosis, previous pelvic radiotherapy, inflammatory pelvic disease history, any other concurrent surgery, laparotomy, robotic surgery, and/or traditional vaginal hysterectomy. RESULTS: Among 86 patients, 21 (24.4%) were allocated to a vNOTES group and 65 (75.6%) were allocated to a conventional laparoscopy (LAP) group. Mean ages for the groups were 47.19 ± 11.11 years and 46.69 ± 9.11 years, respectively (P = 0.928). There were no statistically significant differences in age, body mass index, arterial hypertension/diabetes, smoking, menopausal status, obstetric history, number of abdominal surgeries, or preoperative hemoglobin level between the two groups. The mean (range) operative times were 111.90 min (80-180 min) in the vNOTES group and 113.98 min (64-350 min) in the LAP group (P = 0.904). There were no statistically significant differences in terms of surgery indication, specific and unspecific complications, conversions, blood transfusion, reoperation, significant ileus/emesis, and hospital stay. CONCLUSIONS: Based on the parameters assessed, we found vNOTES to be comparable to laparoscopy among our cohort.