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Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) for Low-grade Endometrial Cancer: The First Fifty Patients
  • alexander burnett,
  • Martha Rojo
alexander burnett
University of Arkansas for Medical Sciences

Corresponding Author:[email protected]

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Martha Rojo
University of Arkansas for Medical Sciences
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Abstract

Study Objective: To review our experience with low-grade endometrial cancer managed with vaginal natural orifice transluminal endoscopic surgery (vNOTES) to determine the feasibility of this approach. Design: Retrospective review of the first fifty cases of endometrial cancer treated by vNOTES Setting: Academic University Population: Fifty consecutive cases of vNOTES management of women with low-grade endometrial cancer were reviewed to detail patient characteristics, operative procedures and outcomes, complications and follow-up. Methods: Patients underwent vNOTES hysterectomy and bilateral salpingo-oophorectomy. If Mayo criteria for lymphadenectomy were met, a laparoscopic lymph node removal was performed. Main Results: Mean age was 63 (33-90); mean BMI was 35.4 (22-58). In 44 women, both tubes and ovaries were removed via vNOTES. Three women had their ovaries retained due to early age, one woman had exploration for removal of an ovary with metastatic disease, and two women had neither tubes nor ovaries removed due to atresia and inability to identify these organs. Two patients underwent laparoscopic lymphadenectomy on the bases of frozen section evaluation. Mean operative time was 98 minutes (30-215). Fourteen patients were discharged the day of surgery; 34 discharged after overnight observation; hospitalization was prolonged in one patient due to ileus and one patient underwent laparotomy 30 hours after vNOTES for bleeding. Conclusion: VNOTES is a feasible management strategy for women with low-grade endometrial cancer. It permits laparoscopic inspection of the abdomen and direct visualization of vascular pedicles. It can provide a rapid recovery with minimal discomfort and no visible scar.