National implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery for benign hysterectomies: A historical cohort study of Swedish data 2021–2023

TL;DR

This study examines the safety and patient satisfaction of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for benign hysterectomies in Sweden.

Contribution

The study provides real-world data on vNOTES hysterectomies in a national setting, showing low complication rates and high patient satisfaction.

Findings

vNOTES hysterectomies in Sweden had low intraoperative and postoperative complication rates.

90% of patients were satisfied or very satisfied with the surgical outcome after one year.

Surgical time and blood loss were comparable to previous observational vNOTES studies.

Abstract

Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a technique combining vaginal entrance to the abdomen with endoscopic overview. Previous studies have shown that vNOTES decreases operating time, hospitalization, postoperative complications, and pain. We aimed to present patient demographics, costs, and surgical outcomes following the implementation of vNOTES for benign hysterectomies in Sweden.

We conducted a historical cohort study with the first vNOTES hysterectomies in Sweden 2021–2023 involving 8 hospitals. Data was extracted from the Swedish National Quality Register for Gynecological Surgery (GynOp). Our main outcomes were intraoperative and postoperative complications, costs, and patient satisfaction. As a secondary objective, the odds ratios (OR) for any intraoperative or postoperative complication, respectively, were computed for BMI ≥30 versus <30, and for uterus weight ≥500 g versus <500 g.

A total of 545 patients were included in the study. The mean age of the patients was 49.9 ± 10.7 years. Of the included patients, 8.1% (n = 44) were nullipara, 19.3% (n = 105) had a BMI ≥30, 17.4% (n = 95) had a previous cesarean section, and 16.7% (n = 91) had other previous abdominal surgery. The median uterus weight was 148 g (interquartile range, IQR 86–299). The median surgical time was 65 minutes (IQR 48–91), and the median blood loss was 40 mL (IQR 25–90). Conversions to laparotomy occurred in 2% (n = 11), and reoperations occurred in 0.6% (n = 3) of the cases. The total intraoperative complication rate was 2.2% and the total postoperative complication rate was 8.4%. No significant differences in intraoperative and postoperative complications were found between BMI ≥30 and <30 and between uterus weight ≥500 and <500 g. Most of the patients (57.1%, n = 311) left the hospital the same day as the surgery. The 1‐year follow‐up after surgery showed that 90% of the patients were satisfied or very satisfied with the result.

The implementation of vNOTES hysterectomies in Sweden has been safe showing similar complication rates compared to studies of other minimally invasive hysterectomy techniques. Surgical time, intraoperative bleeding, and conversions were in analogy with previous observational vNOTES studies. The 1‐year follow‐up after surgery showed high patient satisfaction.

The implementation of vNOTES hysterectomy in Sweden shows low intra‐ and postoperative complication rates. The 1‐year follow‐up after surgery shows that 90% of the patients were satisfied or very satisfied with the result. vNOTES seems to be a safe method to introduce broadly in a national setting.

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