Patients who underwent vaginal natural orifice transluminal endoscopic hysterectomy experienced faster recovery of bowel function and earlier return to work compared with those who had laparoscopic hysterectomy, according to a new prospective cohort study.
In the study, researchers included 330 women diagnosed with high-grade cervical intraepithelial neoplasia (CIN II–III) with or without uterine fibroids or adenomyosis. Among them, 92 underwent vaginal natural orifice transluminal endoscopic hysterectomy (vNOTES) and 238 received laparoscopic hysterectomy (LH). The researchers tracked time to first anal exhaust (a marker of gastrointestinal recovery) and return-to-work (RTW) time.
Median time to first anal exhaust was significantly shorter in the vNOTES group—48 hours vs 69 hours in the LH group (P < .001). Among the patients who were employed, those who underwent vNOTES returned to work sooner, with a median of 2.0 months vs 3.0 months in the LH group (P = .011).
By 4 months following the procedures, 81.8% of the patients who underwent vNOTES resumed work compared with 68.4% of those who underwent LH. At 6 months, all of the patients who underwent vNOTES returned to work compared with just 76.9% of those who underwent LH.
Multivariate analysis showed that surgical approach and hospital stay significantly influenced RTW time. Patients who had vNOTES were more likely to return to work earlier (hazard ratio [HR] = 2.093, 95% confidence interval [CI] = 1.186–3.694, P = .011). Shorter hospital stays also predicted faster RTW (HR = 0.855, 95% CI = 0.748–0.977, P = .021).
Median operation time was shorter with vNOTES (90 minutes vs 110 minutes, P < .001), as was hospital stay (5 days vs 6 days, P = .002).
Cosmetic satisfaction was higher in the vNOTES group, with a median score of 9 out of 10 compared with 8 in the LH group (P < .001). Complication rates were low and not statistically different between the groups. No patient required conversion to open surgery, and no major postoperative complications were reported.
All procedures were conducted by two experienced gynecologic surgeons at a single tertiary hospital, using standardized protocols and strict inclusion criteria. Follow-up lasted up to 15 months.
The findings suggested that vNOTES may promote quicker recovery and earlier return to daily function in women undergoing hysterectomy. The transvaginal route, which avoids abdominal incisions, may contribute to these outcomes without increasing complication risks.
The researchers stated that further multicenter studies are needed to validate the results and assess cost-effectiveness and broader quality-of-life outcomes.
No competing interests were declared.
Source: BMC Surgery