Transvaginal natural orifice transluminal endoscopic surgery （vNOTES）による子宮全摘術の初期経験

抄録

Objective: After the increasing number of recent reports of hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES), we have introduced a novel procedure called vaginally-assisted NOTES hysterectomy (VANH). The objective of this study was to describe the VANH technique step-by-step, assess the technical feasibility of the procedure, and evaluate its initial surgical outcomes.

Methods: We retrospectively reviewed the perioperative outcomes in 20 patients with benign gynecologic disease who underwent VANH (n=10) or total laparoscopic hysterectomy (TLH; n=10) between February and November 2019 at our institution. Patient characteristics, operation time, blood loss, perioperative complications, and postoperative pain scores were compared between the two groups, as well as the amount of oral analgesia used in the first three postoperative days.

Results: There was no significant between-group difference in operation time or length of postoperative hospital stay. Mean estimated blood loss was significantly greater (198 mL vs. 18 mL, p=0.02) and the mean postoperative pain score was significantly lower in the VANH group than in the TLH group. The mean number of oral analgesics used was significantly lower in the VANH group (1.9 vs 3.5, p=0.01).

Conclusion: VANH could be safely introduced at our institution as an alternative approach for hysterectomy and have several benefits, including less postoperative pain and no visible scars. We anticipate that accumulation of more cases will allow us to improve our technique, consider expansion of the surgical indications for VANH, and introduce other vNOTES procedures.