Our Summary

This research paper investigates the impact of a surgical technique called transvaginal natural orifice transluminal endoscopic surgery (vNOTES) on hysterectomy procedures (removal of the uterus) and additional surgeries on nearby organs (adnexal surgeries). The researchers looked at hysterectomies performed for non-cancerous reasons between 2017 and 2019. They split the time period into two: before the first case of vNOTES was implemented (Pre-vNOTES) and after (Post-vNOTES).

They found that after introducing vNOTES, there was a significant increase in the use of vaginal hysterectomies (removal of the uterus through the vagina), as opposed to abdominal or laparoscopic (keyhole surgery) approaches. Before vNOTES, 40.1% of hysterectomies were done vaginally; this increased to 94.3% after vNOTES was introduced. The use of the abdominal method dropped from 37.4% to 3.2%, and the laparoscopic method from 22.5% to 2.5%.

Additionally, the rate of additional surgeries performed at the same time as the hysterectomy also changed. Prior to vNOTES, 39.7% of patients did not have any additional surgeries, this dropped to 8.1% after vNOTES. The number of patients having both their fallopian tubes removed (bilateral salpingectomy) decreased from 49.3% to 14.2%, while the number of patients having their ovaries and fallopian tubes removed (BSO) increased from 6.8% to 75%.

In conclusion, the introduction of vNOTES led to a significant increase in vaginal hysterectomies and the removal of ovaries and fallopian tubes during hysterectomy.

FAQs

  1. What is the impact of the vNOTES surgical technique on hysterectomy procedures and additional surgeries on nearby organs?
  2. How has the introduction of vNOTES changed the methods of performing hysterectomies?
  3. Has the introduction of vNOTES affected the rate of additional surgeries performed at the same time as the hysterectomy?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to discuss with their healthcare provider the different surgical approaches available, including vaginal hysterectomy, and the potential benefits and risks of each option. It is important for patients to be informed and involved in the decision-making process regarding their surgery.

Suitable For

Patients who are typically recommended hysterectomy include those with conditions such as:

  1. Uterine fibroids: Non-cancerous growths in the uterus that can cause heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel.

  2. Endometriosis: A condition where tissue similar to the lining of the uterus grows outside the uterus, causing pain, irregular bleeding, and infertility.

  3. Adenomyosis: A condition where the tissue that lines the uterus grows into the muscular wall of the uterus, causing heavy menstrual bleeding, severe cramping, and pelvic pain.

  4. Uterine prolapse: A condition where the uterus slips down into the vagina due to weakened pelvic floor muscles or ligaments, causing pelvic pressure and discomfort.

  5. Chronic pelvic pain: Persistent pain in the pelvic area that is not relieved by other treatments.

  6. Abnormal uterine bleeding: Irregular, heavy, or prolonged menstrual bleeding that does not respond to other treatments.

  7. Gynecologic cancers: In some cases, hysterectomy may be recommended as part of treatment for cancers such as uterine, cervical, or ovarian cancer.

It is important for patients considering hysterectomy to discuss the risks and benefits of the procedure with their healthcare provider and explore all available treatment options before making a decision.

Timeline

Overall, the timeline for a patient undergoing a hysterectomy before and after vNOTES implementation would involve a consultation with a healthcare provider to discuss treatment options and potential risks. Before vNOTES, the patient may have been scheduled for an abdominal or laparoscopic hysterectomy, with the possibility of additional surgeries such as a bilateral salpingectomy or bilateral salpingo-oophorectomy (BSO).

After vNOTES was introduced, the patient may have been offered a vaginal hysterectomy as the preferred surgical approach. This could result in a shorter recovery time, less pain, and a lower risk of complications compared to traditional methods. Additionally, there may be a higher likelihood of having their ovaries and fallopian tubes removed during the procedure.

Overall, the introduction of vNOTES has led to changes in the surgical approach and additional procedures performed during hysterectomy, potentially improving outcomes for patients undergoing this surgery.

What to Ask Your Doctor

Questions a patient should ask their doctor about hysterectomy in light of this research include:

  1. What surgical approach do you recommend for my hysterectomy, and why?
  2. What are the potential risks and benefits of each surgical approach, including vNOTES, for my specific case?
  3. How does the use of vNOTES affect the likelihood of additional surgeries, such as removal of the ovaries and fallopian tubes, during the hysterectomy?
  4. How will the choice of surgical approach impact my recovery time and potential complications?
  5. Are there any long-term effects or considerations I should be aware of if I choose to have my ovaries and fallopian tubes removed during the hysterectomy?
  6. What alternative treatment options are available for my condition, and how do they compare to hysterectomy with vNOTES or other surgical approaches?
  7. Can you provide more information about your experience and success rates with vNOTES for hysterectomy?

Reference

Authors: Ozceltik G, Hortu I, Itil IM, Yeniel AO. Journal: J Gynecol Obstet Hum Reprod. 2022 Jan;51(1):102241. doi: 10.1016/j.jogoh.2021.102241. Epub 2021 Oct 7. PMID: 34626848