Introduction of Vaginal Natural Orifice Transluminal Endoscopic Surgery: Al-Karak Governmental Hospital Experience

Abstract

Objective: Hysterectomy is a widely performed major gynecologic surgery. However, few studies have examined the outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and compared them with those of conventional laparoscopic hysterectomy. This study assessed if vNOTES hysterectomy is both safe and feasible for patients with noncancerous conditions of the uterus. Materials and Methods: This comparative retrospective study was conducted in the department of obstetrics and gynecology at Al-Karak Governmental Hospital, Karak, Jordan. Data on hysterectomy cases were collected from hospital records for operations between January 2018 and January 2023. There were 2 groups of patients: a total laparoscopic hysterectomy (TLH) group and a vNOTES group. Data from each group were obtained on patients' demographics, indications for surgery, and intraoperative and postoperative parameters. Results: After exclusions, the TLH group had 44 cases and the vNOTES group had 16 cases. Both groups had similar general characteristics with the most-common indication for hysterectomy being fibroid uteri: ∼ ½ of TLH cases, compared to ∼1/3 of vNOTES cases. Patients who had TLH had significantly shorter surgery durations (151.7 ± 50.4 minutes), compared to patients who had vNOTES (176.3 ± 36.9 minutes); p = 0.044. vNOTES resulted in significantly longer hospital stays (1.8 ± 0.5 days) than TLH (1.5 ± 0.5 days); p = 0.029. Conclusions: The vNOTES approach is a novel technique which showed comparable outcomes to conventional laparoscopy. (J GYNECOL SURG 20XX:000)