title: Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of hysterectomy in benign disease using transvaginal natural orifice transluminal endoscopic surgery (NOTES).
  
  
  METHODS
  Prospective observational study (Canadian Task Force classification II-3).
  
  
  METHODS
  Tertiary referral medical center.
  
  
  METHODS
  From May 2010 to August 2011, consecutive patients who were scheduled to undergo laparoscopic hysterectomy and without virginity or suspected pelvic inflammation or cul-de-sac obliteration were included.
  
  
  METHODS
  Total hysterectomy via transvaginal NOTES.
  
  
  RESULTS
  The study included 137 patients, with mean (SEM) age 46.0 (0.4) years and body mass index 24.7 (0.4). Transvaginal NOTES was successfully performed in 130 patients (94.9%). Fifteen patients underwent concurrent adhesiolysis, and 17 underwent adnexal procedures. Mean (SEM) uterine weight was 450.0 (24.1) g; in 45 patients (34.6%), uterine weight was >500 g, and in 7 (5.4%) it was >1000 g. Operative time was 88.2 (4.1) minutes, with blood loss of 257.7 (23.9) mL. In 2 patients there was intraoperative hemorrhage or unintended cystotomy, and in another 5 transvaginal colpotomy failed because of a narrow vagina, cul-de-sac obliteration by bowel adhesions, or mass obstruction. Complications in these 7 patients (5.1%) were successfully managed via transabdominal laparoscopy. Five patients (3.6%) experienced postoperative urinary retention or febrile morbidity, and recovered uneventfully with conservative treatment.
  
  
  CONCLUSIONS
  Transvaginal NOTES is a feasible technique for performance of hysterectomy and can be used in procedures that are difficult to complete via conventional vaginal surgery because posterior colpotomy is achievable. This procedure was not impeded by uterine volume, and had the advantage of no abdominal incision.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University College of Medicine, Taiwan, Republic of China.
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University College of Medicine, Taiwan, Republic of China.
authors.forename: Kai-Yun
authors.initials: KY
authors.lastname: Wu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University College of Medicine, Taiwan, Republic of China.
authors.forename: Hsuan
authors.initials: H
authors.lastname: Su
authors.affiliation: Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan, Republic of China.
authors.forename: Pei-Ju
authors.initials: PJ
authors.lastname: Wu
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University College of Medicine, Taiwan, Republic of China.
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Han
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and University College of Medicine, Taiwan, Republic of China; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan, Republic of China. Electronic address: yen2158@gmail.com.
authors.forename: Chih-Feng
authors.initials: CF
authors.lastname: Yen
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D015992:Body Mass Index; D004724:Endoscopy; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D061646:Operative Time; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Hysterectomy; Laparoscopy; Natural orifice transluminal endoscopic surgery (NOTES); Vaginal surgery