European journal of obstetrics, gynecology, and reproductive biology · 2025
Feasibility and perioperative outcomes of vaginal natural orifice transluminal endoscopic hysterectomy regardless of surgeon experience: A comparison with total laparoscopic hysterectomy.
СтатьяНаблюдательное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Takahashi Akimasa, Kitazawa Jun, Hirata Kimiko, Koikawa Yu, Koikawa Ayae, Nakata Mari
Аннотация
OBJECTIVE: To compare perioperative outcomes, postoperative pain, and systemic inflammatory response between vaginal natural orifice transluminal endoscopic hysterectomy (VANH) and conventional total laparoscopic hysterectomy (TLH) for benign gynecological diseases in a Japanese clinical setting, with particular emphasis on feasibility across different surgeon experience levels.
STUDY DESIGN: This prospective observational study was conducted at the National Hospital Organization Higashi-Ohmi General Medical Center from June 2022 to May 2024. Overall, 117 patients were included, with 62 and 55 undergoing VANH and TLH, respectively. Primary endpoints were the number of analgesic administrations and the maximum numerical rating scale (NRS) score within 5 postoperative days. Secondary endpoints included surgery duration, estimated blood loss, specimen weight, transfusion, complications, readmission, and perioperative changes in hemoglobin and C-reactive protein (CRP) levels.
RESULTS: VANH had a shorter surgery duration (97 vs. 182 min, p < 0.001) but higher estimated blood loss (150 vs. 70 mL, p < 0.001). The decline in hemoglobin did not differ significantly between groups. CRP levels on postoperative day 1 were lower with VANH (0.72 vs. 1.46 mg/dL, p < 0.001). Postoperative pain was reduced in the VANH group, with lower maximum NRS scores (median: 4.0 vs. 5.0, p = 0.016). Fewer analgesics were required (median 0.0 vs. 1.0, p < 0.001), and more patients required no additional analgesia within 5 days (60.7 % vs. 32.1 %, p = 0.002). Complications were low in both groups, with no serious events or deaths.
CONCLUSIONS: VANH showed favorable perioperative profiles, including shorter surgery duration, reduced postoperative pain, and lower systemic inflammatory response compared to TLH, without compromising safety. The findings provide exploratory evidence supporting the potential feasibility of VANH in real-world clinical practice, but further multicenter randomized or adequately adjusted studies are needed to confirm these results.
STUDY DESIGN: This prospective observational study was conducted at the National Hospital Organization Higashi-Ohmi General Medical Center from June 2022 to May 2024. Overall, 117 patients were included, with 62 and 55 undergoing VANH and TLH, respectively. Primary endpoints were the number of analgesic administrations and the maximum numerical rating scale (NRS) score within 5 postoperative days. Secondary endpoints included surgery duration, estimated blood loss, specimen weight, transfusion, complications, readmission, and perioperative changes in hemoglobin and C-reactive protein (CRP) levels.
RESULTS: VANH had a shorter surgery duration (97 vs. 182 min, p < 0.001) but higher estimated blood loss (150 vs. 70 mL, p < 0.001). The decline in hemoglobin did not differ significantly between groups. CRP levels on postoperative day 1 were lower with VANH (0.72 vs. 1.46 mg/dL, p < 0.001). Postoperative pain was reduced in the VANH group, with lower maximum NRS scores (median: 4.0 vs. 5.0, p = 0.016). Fewer analgesics were required (median 0.0 vs. 1.0, p < 0.001), and more patients required no additional analgesia within 5 days (60.7 % vs. 32.1 %, p = 0.002). Complications were low in both groups, with no serious events or deaths.
CONCLUSIONS: VANH showed favorable perioperative profiles, including shorter surgery duration, reduced postoperative pain, and lower systemic inflammatory response compared to TLH, without compromising safety. The findings provide exploratory evidence supporting the potential feasibility of VANH in real-world clinical practice, but further multicenter randomized or adequately adjusted studies are needed to confirm these results.