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Tytuł pozycji:

vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients.

Tytuł :
vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients.
Autorzy :
Nulens K; Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors).
Bosteels J; Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors).
De Rop C; Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors).
Baekelandt J; Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium (all authors). Electronic address: .
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Źródło :
Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2021 Jul; Vol. 28 (7), pp. 1351-1356. Date of Electronic Publication: 2020 Oct 14.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Original Publication: Philadelphia, PA : Elsevier, c2005-
Contributed Indexing :
Keywords: Hysterectomy; Large uterus; Uterine weight; VANH; vNOTES
Entry Date(s) :
Date Created: 20201016 Latest Revision: 20210712
Update Code :
20210712
DOI :
10.1016/j.jmig.2020.10.003
PMID :
33065258
Czasopismo naukowe
Study Objective: To evaluate the outcome of hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) in cases with a large uterus.
Design: A retrospective cohort study.
Setting: Belgian teaching hospital.
Patients: Women who underwent a vNOTES hysterectomy from March 2015 to March 2020 for benign gynecologic disease with a uterine weight of 280 g or more on pathologic examination (N = 114).
Interventions: All women underwent vaginally assisted NOTES hysterectomy. We performed a retrospective analysis of baseline patient characteristics and clinical outcomes.
Measurements and Main Results: The mean age was 50 ± 3.5 years. Twenty-two (19%) patients were obese (body mass index ≥30 kg/m 2 ), and 4 (3.5%) were morbidly obese (body mass index ≥40 kg/m 2 ). Thirty-five (31%) patients were nulliparous, and 15 (13%) women had 1 or more cesarean sections in their medical history. Uterine weight varied from 281 g to 3361 g, with a mean weight of 559 ± 425 g. Mean surgical time was 63 ± 34 minutes. Surgical time was positively associated with uterine size. There were 4 complications: 3 bleeding complications in the first 24 hours after surgery and 1 minor late complication. Conversion to laparotomy for specimen extraction was performed in 1 case (conversion rate 0.9%). There were no conversions to laparoscopy. No ureteric, bladder, or intestinal injuries occurred in this case series, and there were neither life-threatening complications nor intensive care unit admissions.
Conclusion: The vNOTES technique can offer a safe and effective alternative to laparoscopy or laparotomy in cases with a large to very large uterus, even if the patient has a history of cesarean section, obesity, or nulliparity. In 99% of all women in this study, hysterectomy was successfully performed through vNOTES without conversion. By making use of the advantages of endoscopic surgery, vNOTES might broaden the indications of vaginal hysterectomy. Randomized controlled trials are needed to evaluate whether vaginally assisted NOTES hysterectomy is superior to laparoscopic or abdominal hysterectomy in large uteri cases.
(Copyright © 2020 AAGL. Published by Elsevier Inc. All rights reserved.)

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