Vaginal NOTES Retroperitoneal-Approach Hysterectomy
(VNOTES RA-H): 12 Case Series-Surgical Techniques
and Outcomes
Yantapant A, MD1, Roekyindee R, MD1
Affiliation :
1 Unit of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Natural Orifice Transluminal Endoscopic Surgery-Assisted Vaginal Hysterectomy (tVNOTEH) is a scarless surgery
from which patients can recover quickly and experience alleviated post-operative pain. The most popular form of this surgical
technique is the intraperitoneal approach because it is easy and fast; however, it is difficult in single nulliparous patients with high
undescended uterus and may, especially in cases of obliterated cul de sac, result in more injury to the vagina than is normal in the
multiparous group. The retroperitoneal approach is introduced as an alternative in vaginal NOTES retroperitoneal approach-
hysterectomy (VNOTES RA-H) in order to reduce vaginal injury and blood loss, decrease intra-abdominal gas volume, and lower the
risk of internal organ injury.
Objective : To describe vaginal hysterectomy in 12 patients via the retroperitoneal approach.
Materials and Methods : VNOTES RA-H was performed in 12 patients who fulfilled the indications for hysterectomy. No patient had
contraindications for laparoscopic surgery, and therefore all were included in the study. Patients’ indications were as follows: 3
uterine myomas; 3 adenomyoses; 2 endometrial intraepithelial neoplasias (EIN); 2 submucous myomas; and 2 ovarian teratoma
tumors. General information such as operative time (min), estimated blood loss (ml), pain, and the amount of gas used (liters) were
recorded and analyzed.
Results : Mean operative time was 147.91+62.4 min (range 90 to 280 min); average blood loss was 291.67+214.89 ml. (50 to 700 ml);
median gas volume was 260.83 liters (60 to 687 liters); median abdominal pain was 2 (range 0 to 6); median shoulder pain was 0
(range 0 to 7); and median vaginal pain was 0 (range 0 to 3). One patient was readmitted due to stump infection and received
intravascular antibiotics.
Conclusion : The results of VNOTES RA-H compared to the intraperitoneal approach showed no significant difference in terms of
operative time, estimated blood loss or pain. Operative complications were resolved, and this technique is safe for appropriately
selected patients.
Keywords : Retroperitoneal approach, Vaginal NOTES, RA-Hysterectomy, VNOTES RA-H
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