Systematic Review on Hysterectomy By Vaginal Natural Orifice Transluminal Endoscopic Surgery Compared to Laparoscopic Hysterectomy

Study Objective We aimed to report an update of the systematic review and meta-analysis published in 2016, comparing hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) to the laparoscopic approach for benign indications. Design This was a systematic review and meta-analysis. We searched MEDLINE, EMBASE, CENTRAL and additional sources and aimed to retrieve randomised controlled trials (RCTs), controlled clinical trials (CCTs) and prospective/retrospective cohort studies in human subjects that allowed direct comparison of vNOTES to laparoscopy. Primary outcome was the proportion of women successfully treated with the intended approach to perform hysterectomy without conversion to any other technique. Setting N/A. Patients or Participants We included studies in the adult female population, undergoing removal of the uterus for benign gynecological disease. Studies on interventions for genital prolapse or gynecological malignancy were excluded. Interventions N/A. Measurements and Main Results Our search yielded one RCT and five retrospective cohort trials. Pooled analysis of two subgroups showed that, compared to conventional laparoscopy, vNOTES is equally effective to successfully remove the uterus in individuals meeting the inclusion criteria. vNOTES had significantly lower values for operation time, length of stay and estimated blood loss. There was no significant difference in intra-operative and post-operative complications, readmission, pain scores at 24 hours post-operative and change in haemoglobin on day 1 post-operative. Conclusion The available randomised and observational data show that vNOTES hysterectomy is an effective and safe novel technique for women eligible for endoscopic surgery.