Subtotal hysterectomy by natural orifice transluminal endoscopic surgery

Study objective: To introduce the innovative surgical procedure of treating benign uterine pathology with subtotal hysterectomy by natural orifice transluminal endoscopic surgery (NOTES). Design: Prospective observational study. Setting: Tertiary referral medical center. Methods: From June 2014 to May 2016, three patients with benign uterine diseases who were eligible for laparoscopic subtotal hysterectomy were recruited to undergo transvaginal NOTES at a tertiary referral medical center. Intraoperative and postoperative surgical outcomes were measured. Results: Subtotal hysterectomy by transvaginal NOTES was successfully completed in all patients without any conversion to conventional laparoscopy. The operative time was 144±4.5 (138â149) minutes with an average estimated blood loss of 133±62 (50â200) mL. None of the patients required an intraoperative blood transfusion. The mean specimen weight was 140±59 (56â188) g. The final histology reports were uterine leiomyoma and adenomyosis in these three cases. There were no intraoperative or postoperative complications. No case required intraoperative or postoperative blood transfusion. No cases were converted to traditional laparoscopy or laparotomy. Conclusion: Our preliminary results showed the safety and feasibility of subtotal hysterectomy by transvaginal NOTES in selected patients. It is one of the most minimally invasive surgeries and results in invisible scars. Keywords: laparoscopic hysterectomy, laparoscopy, myoma uteri, natural orifice transvaginal endoscopic surgery (NOTES), subtotal hysterectomy