The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients

J Invest Surg. 2022 Apr;35(4):862-867. doi: 10.1080/08941939.2021.1927262. Epub 2021 May 26.

Abstract

Aim: This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients.

Materials and methods: This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m2) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared.

Results: There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years, p = 0.35), parity (2 vs. 3, p = 0.17), and uterine weight (290 vs. 230 g., p = 0.13) The median BMI was 31.6 kg/m2 (30-42.2 kg/m2) in the TLH group and 31.9 kg/m2 (30-54.6 kg/m2) in the vNOTES group (p = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group (p < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7, p = 0.02) and 24th-hour (4 vs. 3, p < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min, p < 0.001) in the vNOTES hysterectomy group than the TLH group.

Conclusion: vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.

Keywords: Hysterectomy; laparoscopy; natural orifice surgery; obesity.

MeSH terms

  • Cross-Sectional Studies
  • Female
  • Humans
  • Hysterectomy / adverse effects
  • Hysterectomy / methods
  • Laparoscopy* / adverse effects
  • Laparoscopy* / methods
  • Natural Orifice Endoscopic Surgery* / methods
  • Obesity / complications
  • Obesity / surgery
  • Pregnancy
  • Retrospective Studies
  • Treatment Outcome