Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China

Abstract

Objective. To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (VNOTES) versus transumbilical laparoscopic single-site surgery (LESS) as a minimal invasive technique. Materials and Method. The women undergoing hysterectomy for benign diseases by VNOTES and LESS from January 2020 to June 2021 in a tertiary hospital in Shanghai were retrospectively analyzed. Results. 361 women were included in our study, with 228 in the VNOTES groups, 129 in the LESS groups, and 4 conversions from VNOTES to LESS technique. The length of a VNOTES hysterectomy was shorter than that of LESS (80.76 min versus 112.09 min; MD -31.34 min; 95% CI -40.24 to -22.43 min; $P<0.001$ ). VNOTES hysterectomy has a quicker gas passage by the anus (18.80 versus 36.49 hours, MD -17.68 hours, 95% CI -20.23 to -15.14 hours, $P<0.001$ ) and associated with a shorter length of hospital stay (2.31 versus 3.77 days, MD -1.46 days, 95% CI -1.75 to -1.17 days, $P<0.001$ ), while with no increase in blood loss during the operation (median 50 versus 50 ml, $P=0.25$ ). Besides, the VAS pain score in the 24th hour after the operation was lower (median 0 versus 0.5, $P<0.001$ ) in the VNOTES group. Four unique phases of the learning curve were identified using cumulative analysis: the mean operation time of phase I was $82.81\pm 31.45\min$ (the initial learning curve of 43 cases), phase II was $72.48\pm 23.66\min$ (the acquisition of command of 91 cases), phase III was $103.77\pm 45.69\min$ (the further learning of 26 cases), and phase IV was $73.18\pm 26.89\min$ (postlearning in 68 cases). Conclusions. VNOTES is noninferior to LESS as a new minimal invasive procedure for hysterectomy, which also allows patients a faster recovery from surgery and to suffer less pain, and its efficiency and feasibility in large uterine need further exploring.