{
    "abstract": "Vaginal assisted Natural Orifice Transluminal Endoscopic Surgery (NOTES) combines the benefits of vaginal and endoscopic surgery. This study presents the results of the first vaginal assisted NOTES hysterectomies (VANH) in The Netherlands.\nA prospective cohort study was performed in two non-academic teaching hospitals in The Netherlands. Data was collected from patients who underwent a VANH for benign indications between August 2019 and April 2023. Baseline characteristics and data of intra- and postoperative surgical outcomes were recorded and analysed. The VANHs were performed by four experienced vaginal and endoscopic gynaecological surgeons.\nA total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61\u00a0%; n\u00a0=\u00a0122), abnormal cervical cytology (15.5\u00a0%; n\u00a0=\u00a031), abdominal pain (11.5\u00a0%; n\u00a0=\u00a023), post ablation/sterilization pain syndrome (3.5\u00a0%; n\u00a0=\u00a07), uterine fibroids (5.0\u00a0%; n\u00a0=\u00a010), atypical endometrial hyperplasia (2.5\u00a0%; n\u00a0=\u00a05) and Lynch or BRCA gene mutation carriers (1.0\u00a0%, n\u00a0=\u00a02). The mean surgical time was 61.4\u00a0min (\u00a0\u00b1\u00a022.8\u00a0min) with a mean blood loss of 88\u00a0mL (\u00a0\u00b1\u00a089\u00a0mL) and a mean uterine weight of 150\u00a0g (\u00a0\u00b1\u00a0112\u00a0g). In 2.0\u00a0% (n\u00a0=\u00a04) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2\u00a0% (n\u00a0=\u00a0105) of the patients planned in day-care. In 2.0\u00a0% (n\u00a0=\u00a04) an intra-operative complication and in 9.0\u00a0% (n\u00a0=\u00a018) a post-operative complication occurred.\nThis study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands.\nGROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.\nMaastricht University, Maastricht, the Netherlands.",
            "firstname": "Ilse P W",
            "initials": "IPW",
            "lastname": "Bekkers"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands.\nGROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.\nMaastricht University, Maastricht, the Netherlands.",
            "firstname": "Rebecca",
            "initials": "R",
            "lastname": "Henschen"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands.",
            "firstname": "Nicol A C",
            "initials": "NAC",
            "lastname": "Smeets"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.\nDepartment Obstetrics and Gynecology, Universitair Ziekenhuis Gent, Corneel Heymanslaan 10, 9000 Gent, Oost-Vlaanderen, Belgium.",
            "firstname": "Huib A A M",
            "initials": "HAAM",
            "lastname": "van Vliet"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Catharina Hospital Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands.",
            "firstname": "Anne",
            "initials": "A",
            "lastname": "Damoiseaux"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Zuyderland Medical Centre Heerlen, Henri Dunantstraat 5, 6419 PC Heerlen, Limburg, the Netherlands.",
            "firstname": "Martine M L H",
            "initials": "MMLH",
            "lastname": "Wassen"
        }
    ],
    "conclusions": "This study shows vNOTES to be a safe and feasible surgical technique and can be safely implemented with appropriate patient selection and skilled surgeons. It highlights the importance of surgeon awareness of the challenges inherent in the initial stages of the implementation of a new surgical technique when performing their first vNOTES procedures. Additional randomized clinical trials are needed to show superiority of vNOTES compared to traditional surgery.",
    "copyrights": "\u00a9 2024 The Authors.",
    "doi": "10.1016/j.eurox.2024.100323",
    "journal": "European journal of obstetrics & gynecology and reproductive biology: X",
    "keywords": [
        "Laparoscopy",
        "VNOTES",
        "Vaginal assisted NOTES hysterectomy",
        "Vaginal hysterectomy"
    ],
    "methods": null,
    "publication_date": "2024-08-02",
    "pubmed_id": "39091980\n26243992\n25724402\n26264829\n34490608\n25655043\n31444108\n33101923\n31539766\n30325565\n33297354\n36818766\n33892619\n32749818\n19782876\n15639683\n33880653\n33248377\n26009278\n19926201\n11117766\n31291917\n35074513\n16950826\n27679173\n25524534\n19126286\n24710800\n37422053\n26945605",
    "results": "A total of 200 patients underwent a VANH. Indications were dysfunctional menstrual bleeding (61\u00a0%; n\u00a0=\u00a0122), abnormal cervical cytology (15.5\u00a0%; n\u00a0=\u00a031), abdominal pain (11.5\u00a0%; n\u00a0=\u00a023), post ablation/sterilization pain syndrome (3.5\u00a0%; n\u00a0=\u00a07), uterine fibroids (5.0\u00a0%; n\u00a0=\u00a010), atypical endometrial hyperplasia (2.5\u00a0%; n\u00a0=\u00a05) and Lynch or BRCA gene mutation carriers (1.0\u00a0%, n\u00a0=\u00a02). The mean surgical time was 61.4\u00a0min (\u00a0\u00b1\u00a022.8\u00a0min) with a mean blood loss of 88\u00a0mL (\u00a0\u00b1\u00a089\u00a0mL) and a mean uterine weight of 150\u00a0g (\u00a0\u00b1\u00a0112\u00a0g). In 2.0\u00a0% (n\u00a0=\u00a04) of the cases a conversion was necessary. Same day discharge (SDD) was feasible in 80.2\u00a0% (n\u00a0=\u00a0105) of the patients planned in day-care. In 2.0\u00a0% (n\u00a0=\u00a04) an intra-operative complication and in 9.0\u00a0% (n\u00a0=\u00a018) a post-operative complication occurred.",
    "title": "Vaginal assisted NOTES hysterectomy in The Netherlands; A prospective cohort study.",
    "xml": "<Element 'PubmedArticle' at 0x788504240d60>"
}