To discuss the feasibility and safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in total hysterectomy.

A retrospective analysis was carried on the patients who underwent vNOTES total hysterectomy at the Shenzhen Hospital of the Chinese Academy of Medical Sciences Cancer Hospital from Apr. to Dec. 2019. The 35 patients baseline information and surgical status of patients were compared with transumbilical single-hole laparoscopy and traditional laparoscopy approaches which had reported in literatures.

The baseline conditions of patients in vNOTES group, transumbilical single-hole laparoscopy group and traditional laparoscopy group were basically balanced and comparable. The operation time of vNOTES group was 45 to 172 min, with an average of (92.9±29.8)min; the intraoperative blood loss was 20 to 400 ml, with an average of (119.4±83.9)ml; the indwelling catheter time was 10 to 41h, with an average of (22.0±7.4)h; The postoperative bed leaving time was 5 to 24 h, with an average of (17.3±4.2)h; the postoperative exhaust time was 5 to 32 h, with an average of (16.8±6.8) hours; the preoperative and postoperative hemoglobin difference was 0 to 45 g/L, with an average of (13.6±11.1) g/L; the VAS score was 0 to 3 at 24 h after operation, with an average of (1.0±1.1)points; Postoperative patient satisfaction score was 8 to 10, with an average of (9.6±0.6)points. No adjacent organ damage, blood transfusion and postoperative infections occurred. There was no statistical difference in operation time among the three groups (P >0.05). The intraoperative blood loss in the vNOTES group were more than those in the transumbilical single-hole laparoscopic group and the traditional laparoscopic group (P<0.01). The vNOTES group had shorter postoperative exhaust time than the other two groups, The VAS score is lower than the traditional laparoscopic group, and the differences are statistically significant (P<0.01). The results of the subgroup comparison showed that the operation time of vNOTES in hysterectomy of large uterus group is longer than the traditional laparoscopic group(P<0.05). Compared with the transumbilical single-hole laparoscopic group and the traditional laparoscopic group, the vNOTES in hysterectomy of large uterus group had more intraoperative blood loss and shorter postoperative exhaust time, the differences are both statistically significant (P<0.01).

vNOTES total hysterectomy is a safe and feasible surgical method, which is superior to transumbilical single-hole laparoscopy and traditional laparoscopy in terms of postoperative recovery and patient satisfaction. vNOTES in total hysterectomy of large uterus may have advantages.