Natural orifice transluminal endoscopic surgery (NOTES) subtotal hysterectomy: A feasibility study

Objective: Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES) has been carried out for benign uterine diseases and nonprolapsed uteri in recent years. Subtotal hysterectomy was performed to remove the uterus with preservation of the cervix by abdominal, laparoscopic, or vaginal routes. The aim of this retrospective study is to gain insight into the feasibility and safety of subtotal hysterectomy through transvaginal NOTES. Materials and methods: This is the first case series study to describe the technique and to evaluate the feasibility of this innovative surgical procedure. 10 patients were recruited and underwent NOTES subtotal hysterectomy within one-year duration. Results: The mean operative time was 106.7 ± 40.0 min with a mean blood loss of 250.0 ± 120.2 mL. The mean weight of specimen retrieved was 452.2 ± 227.8 g (range 195 g–905 g). None of these patients sustained injury to surrounding structures or major blood vessels during the surgery. Five patients required analgesia during the first 24 h post-surgery. Post-operative hospital stay ranged from 2 to 3 days. No patients complained of surgical complications at 1, 3, and 6 months follow-up. All patients recovered uneventfully and carried on daily activities without difficulty. Conclusion: This study confirms the feasibility and safety of NOTES subtotal hysterectomy.