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PubMed · 42137913

Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.

Ilse P W Bekkers·Floor R M Wintraecken·Nicol A C Smeets·Anne Damoiseaux·Jacques W M Maas·Huib A A M van Vliet·Martine M L H Wassen
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Abstract

OBJECTIVE: To compare Vaginal Hysterectomy (VH) with Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) hysterectomy (VANH) as a day-care procedure. DESIGN: Single-blind, multicentre randomised controlled trial. SETTING: Two Dutch non-academic teaching hospitals. POPULATION: Women aged &#x2265;&#x2009;18&#x2009;years undergoing hysterectomy for benign indications. METHODS: Women were randomised 1:2 (VH or VANH). Primary outcome was SDD. Secondary outcomes included operative time, rate of elective salpingectomies, intraoperative blood loss, complications (Clavien-Dindo), pain scores (NRS) and analgesic use, post-operative recovery (RI-10), and quality of life (EQ-5D-5L). Analyses were performed on an intention-to-treat basis. RESULTS: A total of 113 patients were included in the analyses (n&#x2009;=&#x2009;42 VH, and n&#x2009;=&#x2009;71 VANH). SDD occurred significantly more frequently in the VANH group (87.3%) than VH group (71.4%; OR 2.76, 95% CI 1.04-7.25; p&#x2009;=&#x2009;0.04). VANH was associated with a significantly shorter operative time (median 55&#x2009;min versus 65&#x2009;min; p&#x2009;=&#x2009;0.005), less blood loss (median 50&#x2009;mL vs. 150&#x2009;mL; p&#x2009;<&#x2009;0.001) and more often elective opportunistic salpingectomy compared to VH (100% vs. 77.4%; p&#x2009;=&#x2009;0.008). NRS were significantly lower in the VANH group the first hour post-operative (3 vs. 1, p&#x2009;<&#x2009;0.001). Post-operative complications (VH 9.5% vs. VANH 15.5%; p&#x2009;=&#x2009;0.34), readmission (VH 4.8% vs. VANH 8.5%; p&#x2009;=&#x2009;0.47), analgesic use, recovery, and quality of life were not statistically significant. CONCLUSIONS: VANH is a safe and effective alternative to VH, offering a higher likelihood of SDD, shorter operative time, reduced blood loss, and more often an elective salpingectomy, without increased complications or differences in pain, recovery, or quality of life.

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HumansFemaleHysterectomy, VaginalNatural Orifice Endoscopic SurgeryOperative TimeSingle-Blind MethodMiddle AgedBlood Loss, SurgicalPostoperative PainQuality of LifeTreatment OutcomePostoperative ComplicationsAdultSalpingectomyAgedNetherlandsrandomised controlled trialsame&#x2010;day dischargevaginal assisted NOTES hysterectomyvaginal hysterectomyJournal ArticleRandomized Controlled TrialMulticenter StudyComparative Study

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Ilse P W Bekkers, Floor R M Wintraecken, Nicol A C Smeets, Anne Damoiseaux, Jacques W M Maas, Huib A A M van Vliet, Martine M L H Wassen. 2026-05-15. Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial.. https://doi.org/10.1111/1471-0528.70260

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Adult subjectAged subjectComparative Study subjectFemale subjectHumans subjectJournal Article subjectMiddle Aged subjectMulticenter Study subjectNetherlands subjectOperative Time subjectRandomized controlled trials study

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