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Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri

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Abstract

Background

Natural orifice transluminal endoscopic surgery has shown its prospection as a minimally invasive endoscopic surgery. This study aimed to examine the safety and feasibility of transvaginal natural orifice transluminal endoscopic hysterectomy (tVNOTEH) for nonprolapsed uteri in the management of benign gynecological diseases.

Methods

Records were reviewed for the 147 consecutive tVNOTEH procedures between April 2011 and October 2013. Age, body mass index, number of vaginal delivery, and specimen weight were used to select comparable patient who had undergone laparoscopically assisted vaginal hysterectomy (LAVH).

Results

A total of 512 patients were recruited in this study (147 tVNOTEHs and 365 LAVHs, respectively). These patients were stratified into six subgroups according to the uterine weight and type of hysterectomy. There was no incidence of switching to abdominal laparatomy. Length of operation, estimated blood loss (EBL), requirement of blood transfusion, and length of postoperative stay were significantly greater in the LAVH group than in the tVNOTEH group but total hospital charges were higher in the tVNOTEH group (p < 0.001). There was no difference in overall incidence of operative complications between the two groups but more complications in LAVH for uterine weight more than 500 g (4.3 vs. 0 %, p < 0.001); this likely reflects higher hospital charges in this subgroup. Significant linear correlations of uterine weight with operating time and EBL existed in both groups.

Conclusion

tVNOTEH can be safely performed for large and nonprolapsed uterus. Besides, as uterine weight increased, the operative efficiency of tVNOTEH increases compared with LAVH.

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Acknowledgments

This research was supported in part by the National Science Committee Research Grant; grant number NMRPD1B0401 (to Chin-Jung Wang), but this study was not sponsored by any surgical device company. The authors thank Ms. Hsiao-Jung Tseng for statistical consultation, who was supported by grants from Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital (CLRPG340599).

Disclosures

Chin-Jung Wang, Hui-Yu Huang, Chen-Ying Huang, and Hsuan Su have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5, Fu-Hsin Street, Kwei-Shan, Tao-Yuan, Taiwan

    Chin-Jung Wang, Hui-Yu Huang, Chen-Ying Huang & Hsuan Su

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  1. Chin-Jung Wang
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  2. Hui-Yu Huang
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  3. Chen-Ying Huang
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  4. Hsuan Su
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Correspondence to Chin-Jung Wang.

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Wang, CJ., Huang, HY., Huang, CY. et al. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri. Surg Endosc 29, 100–107 (2015). https://doi.org/10.1007/s00464-014-3639-y

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  • DOI: https://doi.org/10.1007/s00464-014-3639-y

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