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Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience

BACKGROUND: The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy. MATERIALS AND METHODS: All women who underwent vNOTES hysterectomy ± salpi...

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Autores principales: Interdonato, Maria Lieta, Scollo, Paolo, Bignardi, Tommaso, Massimello, Francesca, Ferrara, Martina, Donatiello, Gianluca, Caretto, Marta, Mannella, Paolo, Pecorino, Basilio, Meroni, Mario Giuseppe, Simoncini, Tommaso
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792506/
https://www.ncbi.nlm.nih.gov/pubmed/36582280
http://dx.doi.org/10.3389/fmed.2022.1018232
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author Interdonato, Maria Lieta
Scollo, Paolo
Bignardi, Tommaso
Massimello, Francesca
Ferrara, Martina
Donatiello, Gianluca
Caretto, Marta
Mannella, Paolo
Pecorino, Basilio
Meroni, Mario Giuseppe
Simoncini, Tommaso
author_facet Interdonato, Maria Lieta
Scollo, Paolo
Bignardi, Tommaso
Massimello, Francesca
Ferrara, Martina
Donatiello, Gianluca
Caretto, Marta
Mannella, Paolo
Pecorino, Basilio
Meroni, Mario Giuseppe
Simoncini, Tommaso
author_sort Interdonato, Maria Lieta
collection PubMed
description BACKGROUND: The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy. MATERIALS AND METHODS: All women who underwent vNOTES hysterectomy ± salpingo-oophorectomy for benign indications at three tertiary referral medical centers between July 2019 and April 2021 were included in a retrospective analysis. All vNOTESs were performed with the use of Alexis(®) and Vpath Gel paths(®) (Applied Medical). Perioperative data were extracted from patient records. Patient satisfaction and dyspareunia were prospectively inquired about at 60 days and 6 months. RESULTS: Forty-six patients underwent vNOTES in the study period. Indications for surgery included myomas ± metrorrhagia (52.2%), H-Sil/in situ cervical cancer (10.7%), adenomyosis ± metrorrhagia (8.7%), BRCA 1-2 mutations (6.5%), endometrial hyperplasia (6.5%), ovarian cyst + history of breast cancer (6.5%), metrorrhagia (6.5%), and hydatidiform mole (2.2%). The mean operation time was 91.1 (±32.6) minutes. The mean hemoglobin drop was 1.2 (±0.8). The mean visual analog scale at 24 h for post-operative pain was 3.3 (±1.8). Secondary to our limited experience with the surgical technique, we favor discharge only from day 1. The mean length of hospital stay was 2 (±1.4) days. Two conversions to conventional laparoscopy were reported (4.3%), due to an obliterated pouch of Douglas and a preoperative complication. Two post-operative complications were reported (4.3%). Overall, our data on peri- and post-operative outcomes are similar to those already published for vNOTES. CONCLUSION: Our initial experience suggests that introducing vNOTES as an alternative to conventional surgery is feasible and may offer some advantages in selected women.
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spelling pubmed-97925062022-12-28 Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience Interdonato, Maria Lieta Scollo, Paolo Bignardi, Tommaso Massimello, Francesca Ferrara, Martina Donatiello, Gianluca Caretto, Marta Mannella, Paolo Pecorino, Basilio Meroni, Mario Giuseppe Simoncini, Tommaso Front Med (Lausanne) Medicine BACKGROUND: The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy. MATERIALS AND METHODS: All women who underwent vNOTES hysterectomy ± salpingo-oophorectomy for benign indications at three tertiary referral medical centers between July 2019 and April 2021 were included in a retrospective analysis. All vNOTESs were performed with the use of Alexis(®) and Vpath Gel paths(®) (Applied Medical). Perioperative data were extracted from patient records. Patient satisfaction and dyspareunia were prospectively inquired about at 60 days and 6 months. RESULTS: Forty-six patients underwent vNOTES in the study period. Indications for surgery included myomas ± metrorrhagia (52.2%), H-Sil/in situ cervical cancer (10.7%), adenomyosis ± metrorrhagia (8.7%), BRCA 1-2 mutations (6.5%), endometrial hyperplasia (6.5%), ovarian cyst + history of breast cancer (6.5%), metrorrhagia (6.5%), and hydatidiform mole (2.2%). The mean operation time was 91.1 (±32.6) minutes. The mean hemoglobin drop was 1.2 (±0.8). The mean visual analog scale at 24 h for post-operative pain was 3.3 (±1.8). Secondary to our limited experience with the surgical technique, we favor discharge only from day 1. The mean length of hospital stay was 2 (±1.4) days. Two conversions to conventional laparoscopy were reported (4.3%), due to an obliterated pouch of Douglas and a preoperative complication. Two post-operative complications were reported (4.3%). Overall, our data on peri- and post-operative outcomes are similar to those already published for vNOTES. CONCLUSION: Our initial experience suggests that introducing vNOTES as an alternative to conventional surgery is feasible and may offer some advantages in selected women. Frontiers Media S.A. 2022-12-13 /pmc/articles/PMC9792506/ /pubmed/36582280 http://dx.doi.org/10.3389/fmed.2022.1018232 Text en Copyright © 2022 Interdonato, Scollo, Bignardi, Massimello, Ferrara, Donatiello, Caretto, Mannella, Pecorino, Meroni and Simoncini. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Medicine
Interdonato, Maria Lieta
Scollo, Paolo
Bignardi, Tommaso
Massimello, Francesca
Ferrara, Martina
Donatiello, Gianluca
Caretto, Marta
Mannella, Paolo
Pecorino, Basilio
Meroni, Mario Giuseppe
Simoncini, Tommaso
Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title_full Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title_fullStr Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title_full_unstemmed Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title_short Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience
title_sort hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: an italian initial experience
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9792506/
https://www.ncbi.nlm.nih.gov/pubmed/36582280
http://dx.doi.org/10.3389/fmed.2022.1018232
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