Impact of Uterine Weight and Shape on vNOTES Hysterectomy : Analysis of 238 Consecutive Cases

Article Article scientifique Article Impact of Uterine Weight and Shape on vNOTES Hysterectomy : Analysis of 238 Consecutive Cases eng 2023-11-21 2024-02 author Hurni Yannick Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). Electronic address: yhurni@gmail.com. author Fung Helen Faculty of Medicine, University of Geneva, Geneva, Switzerland (Ms. Fung). 928177 author Simonson Colin Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). author Serio Marcello Di Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). author Lachat Régine Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). author Bodenmann Pauline Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). author Seidler Stéphanie Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber). author Huber Daniela Department of Gynecology and Obstetrics, Valais Hospital, Sion, Switzerland (Drs. Hurni, Simonson, Di Serio, Lachat, Bodenmann, Seidler, and Huber); Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland (Dr. Huber). 788725 Département de Pédiatrie, Gynécologie et Obstétrique (PETRI) Daniela Emanuela Huber 115-122 10.1016/j.jmig.2023.11.008 37981263 1553-4650 https://www.sciencedirect.com/science/article/pii/S1553465023009627 Study objective: To compare the perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies for different uterine weights and shapes. Design: Observational study. Setting: Swiss teaching hospital. Patients: Women who underwent vNOTES hysterectomy for benign conditions between May 2020 and July 2023 (N = 238). Patients were divided into 4 subgroups depending on uterus weight and shape. Uteri weighting <280 g were classified as type 0. Uteri weighting ≥280 g were categorized as type 1 (no vascular pedicle displacement), type 2 (cranial displacement of adnexal vascular pedicles), and type 3 (displacement of uterine arteries). Interventions: All women underwent vNOTES hysterectomies. We compared perioperative outcomes for the 4 subgroups. Measurement and main results: We classified 168 patients (70.6%) as uterus type 0, 33 patients (13.9%) as type 1, 24 patients (10.1%) as type 2, and 13 patients (5.4%) as type 3. Mean uterine weight was 135.8 ± 59.5 g in type 0, 398.0 ± 167.3 g in type 1, 603.5 ± 217.9 g in type 2, and 661.7 ± 281.6 g in type 3. Operative time in type 0 (65.1 ± 30.9 minutes) and type 1 (65.1 ± 24.0 minutes) was shorter than in type 2 (102.3 ± 60.0 minutes) and type 3 (115.2 ± 40.3 minutes). Blood losses were more significant in type 2 (158.5 ± 212.0 mL) and type 3 (158.5 ± 110.7 mL) than in type 0 (85.6 ± 113.5 mL). No difference in the rate of total complications among groups was observed (8.3%, 3.0%, 12.5%, and 15.4% in types 0, 1, 2, and 3, respectively). Conclusion: The displacement of the vascular pedicles seems associated with longer operative time and more blood loss and could represent a marker for technical difficulty in vNOTES hysterectomy. However, it does not influence the perioperative complication rate. Enlarged uteri Hysterectomy Minimally invasive surgery Natural orifice transluminal endoscopic surgery VNOTES Dewey 618 58 Département de pédiatrie, gynécologie et obstétrique 223 false Journal of minimally invasive gynecology 31 2 33d62d50-5a9f-4154-92f0-9c52f39060a2 Article (Published version) Restricted 1-s2.0-S1553465023009627-main.pdf 641896 application/pdf 38f457599a9bad91deef635e412a313cd246f7952212f6437ac8d89cc9065579 restrictedAccess Faculté de médecine / Section de médecine clinique / Département de pédiatrie, gynécologie et obstétrique

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Impact of Uterine Weight and Shape on vNOTES Hysterectomy : Analysis of 238 Consecutive Cases	Journal of minimally invasive gynecology			2024	64	0

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