The outcomes of transvaginal NOTES hysterectomy in various uterine sizes.

OBJECTIVES: Natural orifice transluminal endoscopic surgery (NOTES) is an emerging technique in the area of minimally invasive procedures. Preliminary reports have confirmed transvaginal NOTES to be a safe and feasible method for performing hysterectomy and adnexal procedures. However, there are limitations regarding the feasibility of performing transvaginal NOTES hysterectomy in various uterine sizes.

MATERIALS AND METHODS: Two hundred and seventy-five women who had undergone transvaginal NOTES hysterectomy for benign pelvic lesions were recruited from May 2012 to May 2016. Their medical records were retrospectively reviewed. All patients were placed into one of three groups depending on weight of the surgical specimen in order to assess surgical outcomes.

RESULTS: One hundred ninety-one patients (69.46%) had a uterine weight of <500 g (group 1), 67 (24.36%) had a uterine weight of 500-999 g. (group 2), and 17 (6.18%) had a uterine weight of ≥1000 g. (group 3). The mean age± SD of group 1, group 2, and group 3 were 48.68 ± 6.63, 47.22 ± 3.81, and 46.53 ± 2.96 years, respectively (p value = 0.110). There was no statistical differences in terms of parity, body mass index (BMI), or history of abdominal surgery among the three groups. With regard to surgical outcomes, the mean operative times (Standard error: SE) were 76.70 (0.68), 99.99 (1.14), and 152.88 (3.37) minutes in Group 1, Group 2, and Group 3, respectively. The mean amounts of blood loss (SE) was 180.85 (4.61), 342.57 (6.98), and 532.35 (11.85) ml in Group 1, 2, and 3, respectively. There were statistically significant differences in terms of operative time and blood loss among the three groups (p = 0.0001 and 0.0001, respectively).

CONCLUSIONS: Although the size of uterus has a significant effect on operative time and blood loss, NOTES hysterectomy can be successfully performed without any increase in complication rates. Natural orifice transluminal endoscopic surgery hysterectomy is a safe and feasible procedure even in large uteri.