Single Centre Review of Hysterectomy by Abdominal Laparoscopy and Vaginal Natural Orifice Transluminal Endoscopic Surgery

BACKGROUND: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimally invasive surgical technique that can be used for hysterectomy. The technique combines the advantages of vaginal hysterectomy, such as shorter operating times and recovery, with the benefits of laparoscopy. AIMS: The aim of this study is to describe and compare patient demographics, procedural characteristics, and outcomes for total laparoscopic (TLH) and vaginal assisted NOTES hysterectomy (VANH). MATERIALS AND METHODS: This is a retrospective cohort study of all VANH surgeries performed by a single surgeon over a two-year period at Caboolture Hospital in Queensland, Australia. Procedural steps and peri-operative care were standardised and for comparison patients were grouped by procedure type. RESULTS: The study sample comprised 150 cases evenly divided between TLH and VANH. On average, VANH was a faster procedure, with higher median blood loss. There was no significant difference in analgesia requirements and there was a trend toward shorter hospital stay. VANH was more often associated with vaginal repair or sacrospinous fixation, and this patient group had the highest blood loss, duration of surgery, and length of stay. There was no significant difference in complications. CONCLUSIONS: With careful patient selection and suitable training, the risks are comparable with TLH and VANH. The benefits are higher for specific patients and the surgical approach at time of hysterectomy should be individualised.