Introduction of Hybrid Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) and the therapeutic outcomes

Abstract

Objective: Since 2021, we have introduced vNOTES (Transvaginal Natural Orifice Transluminal Endoscopic Surgery) for Reduced Port Surgery in laparoscopic total hysterectomy. The vNOTES uses a natural vaginal orifice, which is less painful and more aesthetic. However, performing surgery for severe adhesions and narrow vaginas is challenging; thus, case selection is essential. Therefore, we started Hybrid vNOTES with umbilical port and have performed it in seven cases to date. In this study, we retrospectively reviewed these cases and compared the surgical results with those of conventional multiport laparoscopic surgery.

Results: The median age of the seven patients was 48 years. There were no nulliparous women, and the median body mass index was 21.4. The median uterine weight was 213 g. The median operative time and blood loss were 129 minutes and 121 g, respectively. One case required additional ports due to intraoperative adhesions. The median postoperative hospital stay was four days, and no perioperative complications were observed. Surgical time was significantly shorter, and postoperative blood tests showed lower C-reactive protein levels in the Hybrid vNOTES group than in multiport laparoscopic surgery. In contrast, intraoperative blood loss was significantly higher in the Hybrid vNOTES group than in multiport laparoscopic surgery.

Conclusion: Hybrid vNOTES was introduced as an initial experience of vNOTES. Although there were advantages over multiport surgery, such as shorter surgery time, there were still issues to be addressed for Pure vNOTES. Further case accumulation is necessary to reduce the complications associated with trocar insertion and to expand vNOTES indications from the standpoint of its cosmetic properties.