open access
Transvaginal natural orifice endoscopic surgery (vNOTES) for elderly patients
, 2, 3, 4, 1
Affiliations- Department of Gynecogic Oncology, Health Sciences University, Dr. Lutfi Kırdar Kartal Training and Research Hospital, Istanbul, Türkiye, Türkiye
- University of Health Sciences, Ümraniye Training and Research Hospital, Istanbul, Türkiye, Türkiye
- Department of Obstetrics and Gynecology, University of Health Science, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Türkiye, Türkiye
- Department of Obstetrics and Gynecology, Special Clinic, Istanbul, Türkiye
open access
Abstract
Objectives: To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients 70 years and over.
Material and methods: The study consisted of eleven patients aged 70 and over who underwent vNOTES for a variety of gynaecological indications at a tertiary referral hospital. The medical and surgical data were noted: age, parity, history of comorbidity, number and type of previous surgeries, body mass index (BMI), operating time, the requirement of intraoperative conversion, the presence of intra- or postoperative complication, estimated blood loss, pre-and postoperative hemoglobin levels, visual analog scale (VAS) pain scores at 6th, 12th and 24th hours, length of hospital stay, and the final pathology results.
Results: vNOTES surgery was performed safely and successfully in eleven patients. There were no intra- and postoperative complications or instances of conversions to conventional laparoscopy or laparotomy. The mean age of patients was 75.91 ± 6.47 (range 70–93), and the mean BMI was 42.49 ± 8.77 kg/m2 (range 30.2–56). Seven cases of endometrioid adenocarcinoma, two cases of uterine leiomyoma, one case of complex atypical hyperplasia, and one case of postmenopausal uterine bleeding due to atrophic endometrium were diagnosed. All endometrial carcinomas were early stage; no adjuvant therapy was needed.
Conclusions: vNOTES seems to be a safe and feasible approach for the treatment of gynecologic pathologies in elderly patients. This study suggests that vNOTES become a viable treatment option for existing minimally invasive procedures since it offers better surgical outcomes in various gynecologic surgeries.
Abstract
Objectives: To evaluate the feasibility and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients 70 years and over.
Material and methods: The study consisted of eleven patients aged 70 and over who underwent vNOTES for a variety of gynaecological indications at a tertiary referral hospital. The medical and surgical data were noted: age, parity, history of comorbidity, number and type of previous surgeries, body mass index (BMI), operating time, the requirement of intraoperative conversion, the presence of intra- or postoperative complication, estimated blood loss, pre-and postoperative hemoglobin levels, visual analog scale (VAS) pain scores at 6th, 12th and 24th hours, length of hospital stay, and the final pathology results.
Results: vNOTES surgery was performed safely and successfully in eleven patients. There were no intra- and postoperative complications or instances of conversions to conventional laparoscopy or laparotomy. The mean age of patients was 75.91 ± 6.47 (range 70–93), and the mean BMI was 42.49 ± 8.77 kg/m2 (range 30.2–56). Seven cases of endometrioid adenocarcinoma, two cases of uterine leiomyoma, one case of complex atypical hyperplasia, and one case of postmenopausal uterine bleeding due to atrophic endometrium were diagnosed. All endometrial carcinomas were early stage; no adjuvant therapy was needed.
Conclusions: vNOTES seems to be a safe and feasible approach for the treatment of gynecologic pathologies in elderly patients. This study suggests that vNOTES become a viable treatment option for existing minimally invasive procedures since it offers better surgical outcomes in various gynecologic surgeries.
Keywords
elderly; hysterectomy; natural orifice surgery; transvaginal NOTES
About this articleTitle
Transvaginal natural orifice endoscopic surgery (vNOTES) for elderly patients
Journal
Issue
Article type
Research paper
Pages
175-180
Published online
2023-10-23
Page views
356
Article views/downloads
332
DOI
Pubmed
Bibliographic record
Ginekol Pol 2024;95(3):175-180.
Keywords
elderly
hysterectomy
natural orifice surgery
transvaginal NOTES
Authors
Emre Mat
Pınar Yıldız
Rezzan Berna Temoçin
Özgür Kartal
Esra Keles
References (28)- United Nations Department of Economic and Social Affairs, Population Division (2020) World Population Ageing 2020 Highlights: Living arrangements of older persons (ST/ESA/SER.A/451). https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/undesa_pd-2020_world_population_ageing_highlights.pdf.
- Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203(6): 865–877.
- Raats JW, van Eijsden WA, Crolla RM, et al. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients. PLoS One. 2015; 10(8): e0136071.
- Hughes S, Leary A, Zweizig S, et al. Surgery in elderly people: preoperative, operative and postoperative care to assist healing. Best Pract Res Clin Obstet Gynaecol. 2013; 27(5): 753–765.
- Weber DM. Laparoscopic surgery: an excellent approach in elderly patients. Arch Surg. 2003; 138(10): 1083–1088.
- Scarpa M, Di Cristofaro L, Cortinovis M, et al. Minimally invasive surgery for colorectal cancer: quality of life and satisfaction with care in elderly patients. Surg Endosc. 2013; 27(8): 2911–2920.
- Robinson CN, Balentine CJ, Marshall CL, et al. Minimally invasive surgery improves short-term outcomes in elderly colorectal cancer patients. J Surg Res. 2011; 166(2): 182–188.
- Kale A, Sarıibrahim B, Başol G. Hysterectomy and salphingoopherectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery(NOTES): Turkish surgeons' initial experience. Int J Surg. 2017; 47: 62–68.
- Li CB, Hua KQ. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgeries: A systematic review. Asian J Surg. 2020; 43(1): 44–51.
- Baekelandt J, Kapurubandara S. Benign Gynaecological procedures by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): Complication data from a series of 1000 patients. Eur J Obstet Gynecol Reprod Biol. 2021; 256: 221–224.
- Jeon SW, Choi JS, Lee JH, et al. Is laparoscopic surgery safe in women over 70 years old with benign gynecological disease? J Obstet Gynaecol Res. 2011; 37(6): 601–605.
- Madden N, Frey MK, Joo L, et al. Safety of robotic-assisted gynecologic surgery and early hospital discharge in elderly patients. Am J Obstet Gynecol. 2019; 220(3): 253.e1–253.e7.
- Mat E, Kale A, Gundogdu EC, et al. Transvaginal natural orifice endoscopic surgery for extremely obese patients with early-stage endometrial cancer. J Obstet Gynaecol Res. 2021; 47(1): 262–269.
- Cengiz H, Dagdeviren H, Kanawati A, et al. Is gynaecological laparoscopic surgery safe for elderly women? A comparison study. J Obstet Gynaecol. 2014; 34(7): 616–619.
- Kaya C, Alay İ, Ekin M, et al. Hysterectomy by vaginal-assisted natural orifice transluminal endoscopic surgery: Initial experience with twelve cases. J Turk Ger Gynecol Assoc. 2018; 19(1): 34–38.
- Mat e, Yıldız G, Basol G, et al. Laparoscopic management of bladder injury during total laparoscopic hysterectomy. Southern Clinics of Istanbul Eurasia. 2021.
- Yang E, Nie D, Li Z. Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis. J Surg Res. 2019; 244: 278–290.
- Kaya C, Alay I, Cengiz H, et al. Conventional Laparoscopy or Vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery for Adnexal Pathologies: A Paired Sample Cross-Sectional Study. Journal of Investigative Surgery. 2020; 34(11): 1185–1190.
- Mat E, Yıldız P, Yılmaz TG, et al. Total laparoscopic hysterectomy experience: retrospective results of a tertiary center. Southern Clinics of Istanbul Eurasia. 2021.
- Housmans S, Noori N, Kapurubandara S, et al. Systematic Review and Meta-Analysis on Hysterectomy by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Compared to Laparoscopic Hysterectomy for Benign Indications. J Clin Med. 2020; 9(12).
- Karakaş S, Kaya C, Yildiz Ş, et al. Comparison of vNOTES technique with conventional laparoscopy in gynecological emergency cases. Minim Invasive Ther Allied Technol. 2022; 31(5): 803–809.
- Kaya C, Yıldız Ş, Alay İ, et al. The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients. J Invest Surg. 2022; 35(4): 862–867.
- Tekin AB, Yassa M, Kaya C, et al. Implementing the transvaginal natural orifice transluminal endoscopic surgery (vNOTES) "first" strategy in benign gynecological surgeries. Arch Gynecol Obstet. 2023; 307(4): 1007–1013.
- Alay I, Kaya C, Cengiz H, et al. Apical pelvic organ prolapse repair via vaginal-assisted natural orifice transluminal endoscopic surgery: Initial experience from a tertiary care hospital. Asian J Endosc Surg. 2021; 14(3): 346–352.
- Gupta K, Mehta Y, Sarin Jolly A, et al. Anaesthesia for robotic gynaecological surgery. Anaesth Intensive Care. 2012; 40(4): 614–621.
- Marengo F, Larraín D, Babilonti L, et al. Learning experience using the double-console da Vinci surgical system in gynecology: a prospective cohort study in a University hospital. Arch Gynecol Obstet. 2012; 285(2): 441–445.
- Judd JP, Siddiqui NY, Barnett JC, et al. Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy. J Minim Invasive Gynecol. 2010; 17(4): 493–499.
- Takmaz O, Asoglu MR, Gungor M. Patient positioning for robot-assisted laparoscopic benign gynecologic surgery: A review. Eur J Obstet Gynecol Reprod Biol. 2018; 223: 8–13.
