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Intra- and Postoperative Complications in 4565 vNOTES Hysterectomies : International Registry Cohort Study

Stuart, Andrea LU ; Wagenius, Johanna LU ; Badiglian-Filho, Levon ; Schnabel, Jens ; Montealegre, Alvaro ; Ehrström, Sophia ; Hartmann, Michael ; Vercammen, Jona ; Huber, Daniela and Lingström, Anna , et al. (2024) In BJOG: An International Journal of Obstetrics and Gynaecology
Abstract

Objective: To present the rates of intra- and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise. Design: International register-based cohort study. Setting: Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries. Population: 4565 patients undergoing vNOTES hysterectomy. Methods: Descriptive data are presented in frequencies (n) and percent (%). Main Outcome Measure: Intra- and postoperative complications. Conversions. Results: Intraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of... (More)

Objective: To present the rates of intra- and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise. Design: International register-based cohort study. Setting: Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries. Population: 4565 patients undergoing vNOTES hysterectomy. Methods: Descriptive data are presented in frequencies (n) and percent (%). Main Outcome Measure: Intra- and postoperative complications. Conversions. Results: Intraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (n = 28), vault complications (n = 26) including 11 infected vault hematomas, cystitis (n = 18) and non-specific infections (n = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience. Conclusions: The largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra- and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
conversion, intraoperative complications, minimally invasive surgery, postoperative complications, vNOTES hysterectomy
in
BJOG: An International Journal of Obstetrics and Gynaecology
publisher
Wiley-Blackwell
external identifiers
  • pmid:39552409
  • scopus:85209811815
ISSN
1470-0328
DOI
10.1111/1471-0528.18000
language
English
LU publication?
yes
id
f05bab5b-dde7-47a2-ba06-9417f8c99926
date added to LUP
2025-02-04 10:17:04
date last changed
2025-07-08 22:57:08
@article{f05bab5b-dde7-47a2-ba06-9417f8c99926,
  abstract     = {{<p>Objective: To present the rates of intra- and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise. Design: International register-based cohort study. Setting: Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries. Population: 4565 patients undergoing vNOTES hysterectomy. Methods: Descriptive data are presented in frequencies (n) and percent (%). Main Outcome Measure: Intra- and postoperative complications. Conversions. Results: Intraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (n = 28), vault complications (n = 26) including 11 infected vault hematomas, cystitis (n = 18) and non-specific infections (n = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience. Conclusions: The largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra- and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.</p>}},
  author       = {{Stuart, Andrea and Wagenius, Johanna and Badiglian-Filho, Levon and Schnabel, Jens and Montealegre, Alvaro and Ehrström, Sophia and Hartmann, Michael and Vercammen, Jona and Huber, Daniela and Lingström, Anna and Baekelandt, Jan}},
  issn         = {{1470-0328}},
  keywords     = {{conversion; intraoperative complications; minimally invasive surgery; postoperative complications; vNOTES hysterectomy}},
  language     = {{eng}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{BJOG: An International Journal of Obstetrics and Gynaecology}},
  title        = {{Intra- and Postoperative Complications in 4565 vNOTES Hysterectomies : International Registry Cohort Study}},
  url          = {{http://dx.doi.org/10.1111/1471-0528.18000}},
  doi          = {{10.1111/1471-0528.18000}},
  year         = {{2024}},
}