Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study.
OBJECTIVE
Natural orifice transluminal endoscopic surgery (NOTES) is currently a very important procedure for surgeons. This study aimed to describe the initial clinical experience of NOTES-assisted vaginal hysterectomy (NAVH) and to investigate its feasibility and surgical outcomes compared with single-port laparoscopic-assisted vaginal hysterectomy (SP-LAVH).


METHODS
Retrospective chart analysis (Canadian Task Force classification II-1).


METHODS
One university-affiliated hospital.


METHODS
Women undergoing NAVH or SP-LAVH for benign uterine diseases.


METHODS
NAVH using a novel homemade NOTES system comprised a glove-wound retractor NOTES port or SP-LAVH using conventional laparoscopic instruments and an umbilical glove port.


RESULTS
Since July 2012, 16 patients with benign uterine disease have undergone NAVH. Another 32 paired, SP-LAVH patients from the registered database were used to compare these 2 modalities of laparoscopic-assisted techniques for vaginal hysterectomy. All NAVHs were completed successfully without the need of an additional port or conversion to the standard laparoscopic approach. Intraoperative and postoperative surgical outcomes were assessed in both groups of patients. There was also no significant difference between both groups in perioperative outcomes such as estimated blood loss, decrease in hemoglobin on postoperative day 1, amount of analgesic drugs used, postoperative visual analog scale pain score, and febrile complications, except for operative time and length of postoperative hospital stay. The mean operative time was 70.6 ± 12.8 minutes for NAVH and 93.2 ± 21.4 minutes for SP-LAVH (p < .001). The median postoperative hospital stay was 3.5 days (range, 3-5) for NAVH and 4 days (range, 3-6) for SP-LAVH (p < .001).


CONCLUSIONS
The findings show that NAVH is a feasible and safe surgical technique and has a short operative time and postoperative hospital stay compared with SP-LAVH. This new technique at least offers similar surgical outcomes and superior cosmesis in our opinion compared with SP-LAVH. However, prospective studies are needed to determine its full clinical application.
Department of Obstetrics and Gynecology, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea. Electronic address: womanmed@eulji.ac.kr.
Yun Seok
YS
Yang
Department of Preventive Medicine, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea.
Soo Young
SY
Kim
Department of Nursing, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea.
Myung Haeng
MH
Hur
Department of Obstetrics and Gynecology, Eulji University, Daejeon, Korea.
Kwoan Young
KY
Oh
D000328:Adult; D016063:Blood Loss, Surgical; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D061646:Operative Time; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000601:surgery*
Natural orifice transluminal endoscopic surgery; Single-port laparoscopy; Vaginal hysterectomy