Transvaginal natural orifice transluminal endoscopic surgery total hysterectomy: 12 cases feasibility and safety analysis

Objective To evaluate the feasibility and safety of performing hysterectomy via the transvaginal natural orifice transluminal endoscopic surgery (NOTES). Methods From May through Dec. 2017, 12 patients with benign uterine diseases or endometrial atypical hyperplasia or cervical intraepithelial neoplasia who were eligible for laparoscopic hysterectomy were recruited to undergo transvaginal NOTES in Peking Union Medical College Hospital. The intraoperative and postoperative data were recorded and analyzed. Results All of the 12 cases of hysterectomy and bilateral adnexectomy ( or bilateral salpingectomy) were succeed and performed completely under NOTES without any complications. The average age of 12 patients was (49.17 ± 4.28)year, the average para was 1.5, and the average BMI was 23.9 kg/m2. The mean of the operation time was(98.92 ± 13.39)minutes. The mean blood loss during the NOTES operation was(53.75 ± 21.33)ml. And the average weight of uterine was(105.83 ± 39.19)g, 55-195 g. There was no significant difference in mean hemoglobin level between preoperative and postoperative(119 ± 13.2)g/L in preoperative and(118 ± 12.7)g/L in postoperative). There is no complications in all 12 cases. The average hospitalization time of 12 cases was (2.5 ± 0.52)days. Mean postoperative recovery of gastrointestinal exhaust was (9.42 ± 2.81) hours. And the Vasual analog scoring were (3.00 ± 0.74). After follow-up for(4.17 ± 2.04)months, all the patients′vaginal stump healed well without scar formation. Conclusions Hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) via the transvaginal natural orifice transluminal endoscopic surgery (NOTES) is a safe and feasible surgical procedure. The effects of hysterectomy and bilateral adnexectomy (or bilateral salpingectomy) via NOTES are comparable to those of traditional laparotomy or laparascopic surgery. Because there is no scar on the abdomen and VAS was much lower, so hysterectomy via NOTES has an advantage in cosmetic results and rapid postoperative recovery. Key words: Transvaginal natural orifice transluminal endoscopic surgery; Single-port laparoscopy; Hysterectomy; Adnexectomy; Salpingectomy