Robotic Vaginal NOTES Hysterectomy: Two New Surgical Techniques

Transvaginal Natural Orifice Transluminal Endoscopic Surgery as a Rescue for Total Vaginal Hysterectomy

Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES): A Series of 137 Patients

Objectives:The objective of this study is to report our initial experience with patients undergoing transvaginal natural orifice transluminal endoscopic surgery (NOTES).Materials and Methods:From September 2016 to December 2016, patients who were not virgins and did not have pelvic inflammation or obliteration of the cul-de-sac who underwent NOTES hysterectomy or ovarian cystectomy (OC) were included in the study.Results:Transvaginal NOTES was performed smoothly in six patients, two patients (mean age 35 years, mean body mass index [BMI] 25) received an OC and four patients (mean age 49 years, mean BMI 27) underwent a hysterectomy. One patient with a hysterectomy received concurrent adhesiolysis. The mean surgical times were 74 and 75 min and blood loss was 50 and 87.5 ml in the OC and hysterectomy groups, respectively. One patient with a hysterectomy had a postoperative fever with 38°C last for 2 days. Pain scores were 0 at 48 h postoperatively in both groups.Conclusion:Transvaginal NOTES is a feasible and safe technique for hysterectomy and OC in our patients and those in previous reports. This procedure was minimally invasive with no scars on the abdomen as well as little pain.

To present our initial experiences in transvaginal natural orifice transluminal endoscopic surgery (NOTES) for adnexal surgeries and hysterectomies. From September 2010 to December 2010, a total of 15 patients with benign adnexal or uterine diseases who were eligible for laparoscopic surgeries were recruited to undergo transvaginal NOTES at a tertiary referral medical center. Intraoperative and postoperative surgical outcomes were measured. Transvaginal NOTES was successfully completed in five adnexal surgeries and 10 hysterectomies without complications, an ancillary port on the abdomen, or conversion to conventional laparoscopy or laparotomy. For the 10 hysterectomies, the surgical time was 93.4 ± 6.3 minutes (mean ± standard deviation), intraoperative estimated blood loss 245 ± 54.0 mL, uterine weight 440.1 ± 76.5 g, and the postoperative hospital stay 2.7 ± 0.3 days. No patients required intraoperative blood transfusion. The two tubal sterilizations were completed in 18 minutes and 30 minutes, respectively, with negligible blood loss. The two salpingectomies, including one ruptured ectopic pregnancy with 2000 mL hemoperitoneum, were completed in 62 minutes and 116 minutes, respectively. The enucleation was completed in 64 minutes with 20 mL estimated blood loss. Our preliminary results indicate that transvaginal NOTES for adnexal surgeries and hysterectomies is feasible and safe. However, this procedure is still new and should only be used as an alternative for conventional laparoscopic surgery in highly selected cases.

Robotic Transvaginal Natural Orifice Transluminal Endoscopic Surgery for Resection of Parametrial and Bowel Deeply Infiltrated Endometriosis

224 - Natural Orifice Transluminal Endoscopic Surgery (NOTES) of Hysterectomy and Bilateral Salpingo-Oophrectomy for Female to Male Transgender Men

1397 Vnotes Hysterectomy for Multiple Fibroid Uterus by Atrium Technique

2427 Hysterectomy and Salpingo-Oophorectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-Notes): Video Technical Report

Robotic assisted vaginal natural orifice transluminal endoscopic surgery high uterosacral ligament suspension (NOTES-HUS) for uterine prolapse with and without uterine preservation

Objective Since the first report of transgastric peritoneoscopic surgery in 2004, minimal invasive surgery (MIS) including conventional laparoscopy, natural orifice transluminal endoscopic surgery (NOTES), single incision laparoscopic surgery (SILS), and robotic surgery have gained traction in general and visceral surgery. While laparoscopic surgery is now the gold standard in many institutions, other MIS approaches lag behind in spite of the enthusiasm of few promoters. The present study investigates the current role of NOTES and SILS in Switzerland. Methods All Swiss surgical departments where queried. Heads of department were asked to complete a detailed questionnaire regarding the use of NOTES and SILS techniques, reminders were sent twice. Results Of 93 departments queried, 63 (68%) answered the survey and most were public hospitals (92%). One third of general surgery departments and 46% of visceral surgery departments had the highest accreditation level A and V1, respectively. While up to 27% of the responding hospitals had performed NOTES in the past, only about 9% still use the technique today. Since January 2019, only two departments performed NOTES cholecystectomy, one department NOTES colectomy and three departments NOTES total mesorectal excision. The main reasons for not performing NOTES anymore were lack of perceived benefits, higher costs, increased morbidity in routine procedures, no patient demand, and the lack of surgical expertise. A similar picture was found regarding the use of SILS, with 37% of hospitals having past experience with SILS and only 13% still performing SILS procedures. Yet, significantly more institutions performed a broader range of SILS procedures today: SILS appendectomy (n = 2), SILS cholecystectomy (n = 4), SILS thyroidectomy (n = 1), SILS small bowel resection (n = 2), SILS colonic resection (n = 5), and SILS rectal resection (n = 2). The main reasons for not performing routinely SILS were similar to the rationale against NOTES. Conclusion Due to technical limitations and lack of perceptible benefits, NOTES and SILS are less frequently performed nowadays than they were in the past. Only a minority of departments are still performing NOTES and SILS, including cholecystectomies, appendectomies, thyroidectomies, and bowel resections. Whether the rise in use of robotic techniques correlates with the decrease of NOTES and SILS needs further investigation.

Recent population survey has shown a preference for transumbilical laparoendoscopic single-site surgery (U-LESS) compared with natural orifice transluminal endoscopic surgery (NOTES) for cholecystectomy, assuming similar surgical risk. This study was designed to evaluate the perception and preference of women regarding conventional laparoscopy, U-LESS, and transvaginal NOTES (TV-NOTES) with particular interest to access perception. An anonymous questionnaire on laparoscopic, U-LESS, and TV-NOTES cholecystectomy, without regards to risks or advantages, was given to female medical/paramedical staff (n=100), patients (n=100), and the general population (n=100). Women participants (median age, 35 (range, 16-79) years) were queried about preference, perception of the different accesses, and personal informations. Of the respondents, 54% had children, 79% had stable relationships, and 96% were sexually active (vaginal intercourse). With similar operative risk, 87% preferred U-LESS, 4% TV-NOTES and 8% laparoscopy. LESS/NOTES choice was influenced by a desire of improved cosmetics (82%) and lower pain (44%). 96% had worries regarding transvaginal access, among them: dyspareunia (68%), decreased sensibility during intercourse (43%), refuse of short-term sexual abstinence (40%), and infertility (23%). Transumbilical access evocated worries in 35%: umbilical pain (19%), postoperative umbilical sensibility (15%), and incisional hernia (11%). Postoperative intercourse abstinence after TV-NOTES evocated worries in 76% (defined as 3 weeks in survey): feel less attractive (40%), less feminine (32%), tension with their intimate (35%), lover non-acceptation (20%), possible abortion of new relationship (26%), and feel less comfortable socially (16%). The high acceptation rate for U-LESS approach compared with TV-NOTES may be related to fears regarding postoperative sexuality and fertility. The importance of temporary postoperative sexual abstinence (vaginal intercourse) is high and may be difficult to influence. Future research on TV-NOTES should focus on the access risk to be able to scientifically reassure our patients. For now, U-LESS seems to be favor compared with TV-NOTES for cholecystectomy in female patients.

Cardiopulmonary and immunologic effects of transvaginal natural-orifice transluminal endoscopic surgery cholecystectomy compared with laparoscopic cholecystectomy in a porcine survival model

Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis

Postoperative outcomes and quality of life following hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) compared to laparoscopy in women with a non-prolapsed uterus and benign gynaecological disease: a systematic review and meta-analysis

Aim: In our study, we aimed to comprehensively evaluate the surgical parameters of patients who underwent total laparoscopic hysterectomy (TLH) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and their effects on the development of pelvic organ prolapse (POP) and sexual function one year later. Materials and Methods: This retrospective and comparative study involved a review of medical records for 42 patients who underwent total laparoscopic hysterectomy (TLH) for benign conditions and 42 patients who underwent hysterectomy using vaginal natural orifice transluminal endoscopic surgery (vNOTES) at our clinic between January 2023 and January 2024. Evaluations of preoperative and postoperative pelvic organ prolapse and sexual function were conducted, and the anatomical and functional outcomes of both surgical methods were compared. Results: In this study, there was no statistically significant difference between the groups in terms of age (p < 0.299), BMI (p < 0.819), parity (p < 0.615), surgical indications and menopausal status (p < 0.535) (p > 0.05). The vNOTES method was found to be significantly shorter than TLH in terms of surgical time (vNOTES: 58 min, TLH: 80 min, p < 0.001). However, there was no significant difference between the two methods in terms of preoperative and postoperative hematocrit values, hospital stay and FSFI scores (p > 0.05). Among the POP-Q parameters, a significant difference was observed only in the Aa parameter in favor of the vNOTES method (p < 0.003). Conclusions: In our study, the vNOTES method provided a shorter surgical time and better anterior vaginal support compared to TLH, but both methods offered similar results in terms of sexual function. More comprehensive studies are needed to clarify the long-term effects.