Gynecological natural orifice transluminal endoscopic surgeries from an anesthesiologist’s perspective: A retrospective cohort study

Abstract

Background/Aim: Natural orifice transluminal endoscopic surgical (NOTES) approach allows either transgastric or transvaginal access to the targeted organs by endoscopes without a skin incision. This study aimed to evaluate the intraoperative and postoperative outcomes of patients who underwent vaginally assisted NOTES (VaNOTES) for gynecological surgery. Methods: One hundred ten patients who underwent hysterectomy and/or bilateral salpingo-oophorectomy (BSO) under general anesthesia either with conventional laparoscopy (CL) or VaNOTES methods were examined. The data of the patients were obtained from the medical records retrospectively. Demographic data, perioperative hemodynamic data, Visual Analogue Scale (VAS) scores, and analgesic consumption at the 1st, 6th, and 24th postoperative hours were assessed. Results: Among all patients, the median duration of anesthesia, median operation time, and hospital stay were lower in the VaNOTES group compared to those in CL (P<0.001). The change in perioperative hemodynamic findings was similar in both patient groups. While the median VAS scores were lower in the VaNOTES group at the 6th and 24th postoperative hours in patients with BSO (P=0.024 and P=0.021), those of patients who underwent hysterectomy were lower at the 1st postoperative hour (P=0.002). However, the change in VAS scores was similar in both patient groups. In addition, no postoperative complications or mortality were observed in any of the groups. Conclusion: Application of NOTES technique in gynecological operations may contribute to the reduction of invasive procedures, shorten the duration of surgery and anesthesia, lower pain severity, and improve hospital stay postoperatively.

Keywords

• Gynecologic surgery
• Natural orifice transluminal endoscopic surgery
• Pain assessment

References

1. 1. McGee MF, Rosen MJ, Marks J, Onders RP, Chak A, Faulx A, Chen VK, Ponsky J. A primer on natural orifice transluminal endoscopic surgery: building a new paradigm. Surg Innov. 2006 Jun;13(2):86-93. doi: 10.1177/1553350606290529.
2. 2. Clark MP, Qayed ES, Kooby DA, Maithel SK, Willingham FF. Natural orifice translumenal endoscopic surgery in humans: a review. Minim Invasive Surg. 2012;2012:189296. doi: 10.1155/2012/189296.
3. 3. Terzi H, Turkay U, Uzun ND, Salıcı M. Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology. Int J Surg Case Rep. 2018;51:349-351. doi: 10.1016/j.ijscr.2018.08.053.
4. 4. Kaya C, Alay I, Yildiz S, Cengiz H, Afandi X, Yasar L. The Feasibility of Natural Orifice Transluminal Endoscopic Surgery in Gynecology Practice: Single-Surgeon Experience. Gynecol Minim Invasive Ther. 2020 Apr 28;9(2):69-73. doi: 10.4103/GMIT.GMIT_84_19.
5. 5. Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019 Jan;126(1):105-113. doi: 10.1111/1471-0528.15504.
6. 6. Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients. J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):818-24. doi: 10.1016/j.jmig.2014.03.011.
7. 7. Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012 Jun;51(2):217-21. doi: 10.1016/j.tjog.2012.04.009.
8. 8. Fan JK, Tong DK, Ho DW, Luk J, Law WL, Law S. Systemic inflammatory response after natural orifice translumenal surgery: transvaginal cholecystectomy in a porcine model. JSLS. 2009 Jan-Mar;13(1):9-13.

9. 9. Wang CJ, Huang HY, Huang CY, Su H. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri. Surg Endosc. 2015 Jan;29(1):100-7. doi: 10.1007/s00464-014-3639-y.
10. 10. Schaefer M. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia. F1000 Med Rep. 2009 Oct 29;1:80. doi: 10.3410/M1-80.
11. 11. Robinson DR, Gebhart GF. Inside information: the unique features of visceral sensation. Mol Interv. 2008 Oct;8(5):242-53. doi: 10.1124/mi.8.5.9.
12. 12. Yang YS, Kim SY, Hur MH, Oh KY. Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study. J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):624-31. doi: 10.1016/j.jmig.2014.01.005.
13. 13. Santos BF, Teitelbaum EN, Arafat FO, Milad MP, Soper NJ, Hungness ES. Comparison of short-term outcomes between transvaginal hybrid NOTES cholecystectomy and laparoscopic cholecystectomy. Surg Endosc. 2012 Nov;26(11):3058-66. doi: 10.1007/s00464-012-2313-5.
14. 14. Granberg CF, Gettman MT. Rationale for natural orifice transluminal endoscopic surgery and current limitations. BJU Int. 2010 Sep;106(6 Pt B):908-12. doi: 10.1111/j.1464-410X.2010.09668.x.
15. 15. Hackethal A, Sucke J, Oehmke F, Münstedt K, Padberg W, Tinneberg HR. Establishing transvaginal NOTES for gynecological and surgical indications: benefits, limits, and patient experience. Endoscopy. 2010 Oct;42(10):875-8. doi: 10.1055/s-0030-1255756.
16. 16. Navarro-Ripoll R, Martínez-Pallí G, Guarner-Argente C, Córdova H, Martínez-Zamora MA, Comas J, Rodríguez de Miguel C, Beltrán M, Rodríguez-D'Jesús A, Hernández-Cera C, Llach J, Balust J, Fernández-Esparrach G. On-demand endoscopic CO2 insufflation with feedback pressure regulation during natural orifice transluminal endoscopic surgery (NOTES) peritoneoscopy induces minimal hemodynamic and respiratory changes. Gastrointest Endosc. 2012 Aug;76(2):388-95. doi: 10.1016/j.gie.2011.10.015. PMID: 22817790.
17. 17. Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2014 Jul;208(1):143-50. doi: 10.1016/j.amjsurg.2013.09.027.