当院におけるTransvaginal Natural Orifice Transluminal Endoscopic Surgery（vNOTES）による子宮全摘出術とTotal Laparoendoscopic Hysterectomy（TLH）の比較

抄録

Objective: Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is now widely spread as a minimally invasive surgery. We have performed vaginally assisted NOTES hysterectomy (VANH) since April, 2022. The aim of this study was to compare VANH and total laparoendoscopic hysterectomy (TLH), and discuss the safety and feasibility of this new surgical procedure.

Methods: We retrospectively reviewed perioperative outcomes in 163 patients who underwent VANH (n=66) or TLH (n=97) from April 2022 until March 2023 at our center. We measured baseline characteristics, surgical data, pain score (NRS) after surgery, and the amount of analgesics usage.

Results: No differences were shown in baseline characteristics between the two groups. Operation time was shorter in the VANH group, and estimated blood loss was smaller in the TLH group. The VANH group showed higher postoperative pain on Day 0 than the TLH group, but there was no difference after Day 1. White blood cell count did not differ between the two groups, while C-reactive protein was lower in the VANH group.

Conclusion: This surgery has the advantage of leaving no scars on the patient's body, but contrary to our expectation, higher postoperative pain on Day 0 and amount of blood loss were shown in the VANH group. Those problems need to be solved for further expansion of surgical indication.