1886 Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (Vnotes): Korean Surgeons’ Initial Reports

Study Objective To evaluate feasibility and safety of hysterectomy and adnexal procedures by vNOTES. Design Prospective observational study. Setting Prepare the surgery under general anesthesia and allow the patient to take a Trendelenburg posture. Patients or Participants Most of benign diseases except malignant disease were selected from the surgical candidates. Interventions There is no intervention other than surgery. Measurements and Main Results The first 26 patients were treated with vNOTES. Basic patient characteristics were measured, and the time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38-73). Median BMI was 22.4 (18.2-30.0). Median EBL was measured as 100 ml (20.0-500). The median value of hemoglobin changes before and after surgery was 1.8 (0.2-4.5). The day of hospitalization from the day of surgery was 3 days (3-8). 18 (69.2%) cases had previous vaginal delivery history. 5 cases had previous Cesarean section. Five patients previously underwent a Cesarean section, two of which were Pfannenstiels incision and three of whom were low midline incision. The median portal time was 15 min (4-35) and the median total time was 85 min (43.1-132.0). From the 5th case in the learning curve, the port installation time was significantly shortened. Complications occurred during surgery in three patients who had undergone previous Cesarean section surgery. Two cases of bladder injury occurred during port installation due to adhesion of Cesarean section site and bladder. One case was a reoperation for intraperitoneal hemorrhage on the 13th postoperative day. There were no other complications. Conclusion To date, vNOTES does not seem to lag much behind other surgical methods in our institution. vNOTES is currently undergoing a prospective study, including pain and cosmetic aspects.