Our Summary

This study compared two types of surgery used to remove large uteri (above 280g): the traditional laparoscopic hysterectomy (LH) and the vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy. The study involved 54 patients who had the vNOTES procedure and 52 patients who had the traditional LH.

The results showed that the vNOTES procedure was faster (an average of 99 minutes compared to 171 minutes for the LH procedure) and resulted in a shorter hospital stay (half a night compared to 2 nights for the LH procedure). More patients who had the vNOTES procedure were managed in an outpatient setting (50% compared to only 3.7% for the LH procedure).

There was no significant difference between the two procedures in terms of bleeding or the need to switch to a different surgical approach. Both procedures had very low rates of complications during and after surgery.

In conclusion, for patients with large uteri, the vNOTES procedure is faster, requires a shorter hospital stay, and is more likely to be performed in an outpatient setting than the traditional LH procedure.

FAQs

  1. What are the two types of surgery used to remove large uteri (above 280g) compared in this study?
  2. How does the vNOTES procedure compare to the traditional LH procedure in terms of operation time, hospital stay duration, and outpatient management?
  3. Was there a significant difference in bleeding or the need to switch to a different surgical approach between the vNOTES and LH procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hysterectomy is to ask about the possibility of undergoing a vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy, especially if they have a large uterus. This procedure has been shown to be faster, result in a shorter hospital stay, and have a higher likelihood of being done in an outpatient setting compared to traditional laparoscopic hysterectomy. It is important to discuss all available options with your healthcare provider to determine the best approach for your individual situation.

Suitable For

Patients who have large uteri and are in need of a hysterectomy may be recommended for the vNOTES procedure based on the findings of this study. Additionally, patients who prefer a minimally invasive approach with a faster recovery time and shorter hospital stay may also be good candidates for the vNOTES procedure. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their individual situation.

Timeline

Before hysterectomy:

  • Patient undergoes consultation with gynecologist to discuss reasons for hysterectomy and potential risks and benefits
  • Pre-operative tests and evaluations are conducted to assess overall health and determine if patient is a suitable candidate for surgery
  • Patient may be required to stop taking certain medications or adjust diet leading up to surgery
  • Patient may need to make arrangements for post-operative care and recovery support

After hysterectomy:

  • Patient is monitored in recovery room immediately after surgery for any complications or side effects
  • Patient may experience pain, discomfort, and fatigue in the days following the surgery
  • Patient is given instructions for post-operative care, including wound care, activity restrictions, and pain management
  • Patient may need to attend follow-up appointments with gynecologist to monitor healing and address any concerns
  • Patient may experience changes in hormonal balance and emotions due to removal of uterus
  • Patient may gradually resume normal activities and return to work after a period of rest and recovery.

What to Ask Your Doctor

  1. What are the reasons for recommending a hysterectomy in my case?
  2. What are the potential risks and complications associated with the vNOTES procedure compared to traditional laparoscopic hysterectomy?
  3. How experienced are you in performing the vNOTES procedure compared to the traditional LH procedure?
  4. Will I be a good candidate for the vNOTES procedure based on my medical history and uterine size?
  5. What is the expected recovery time and post-operative care for the vNOTES procedure compared to traditional laparoscopic hysterectomy?
  6. Will I have a choice in the type of procedure used for my hysterectomy, or is one recommended over the other in my case?
  7. How will the vNOTES procedure affect my future reproductive health and hormone levels compared to traditional laparoscopic hysterectomy?
  8. Are there any long-term effects or considerations to keep in mind with the vNOTES procedure compared to traditional laparoscopic hysterectomy?
  9. What are the expected outcomes and success rates for the vNOTES procedure in terms of addressing my uterine condition compared to traditional laparoscopic hysterectomy?
  10. Are there any additional resources or information available to help me make an informed decision about the type of hysterectomy procedure to undergo?

Reference

Authors: Kheirbek N, Delporte V, El Hajj H, Martin C, Delplanque S, Kerbage Y, Rubod C, Cosson M, Giraudet G. Journal: J Minim Invasive Gynecol. 2023 Nov;30(11):877-883. doi: 10.1016/j.jmig.2023.06.019. Epub 2023 Jul 6. PMID: 37422053