Comparative Analysis Of Transumbilical Laparoendoscopic Single Site Surgery(TT-LESS) Versus Transvaginal Natural Orifice Transluminal Endoscopic Surgery(vNOTES) Total Hysterectomy In Women With Benign Uterine Diseases

Objectives:To evaluate the safety and feasibility of transumbilical laparoendoscopic single-site surgery(TU-LESS)versus transvaginal natural orifice transluminal endoscopic surgery(vNOTES)in total hysterectomy with benign indications through discussing the perioperative outcomes and follow-up data.We also discuss possible benefits of both approaches in cases done by one same surgeon or with uterine volume less than 12 gestational weeks.Methods:The clinical data of 95 patients who received TU-LESS(n=72)or vNOTES(n=23)hysterectomy in the Third Affiliated Hospital of Guangzhou Medical University from Jan 2016 to Dec 2019 were analyzed retrospectively.The baseline data(including age,BMI,gravidity,parity,uterine volume,pelvic and abdominal surgery history,pelvic inflammation disease history),perioperative indicators(including operation time,intra-operation bleeding volume,hemoglobin changes,conversion rate,VAS(visual analogue scale)value,surgical complications(including organ injury and massive hemorrhage during the operation,intestinal obstruction,post-operative bleeding and infection after surgery),time to pass gas,time to get back to normal diet,hospitalization stay and hospitalization cost were analyzed.Patients in both groups were followed up by outpatient clinic or telephone at 1 month,3 months,6 months,and 1 year after surgery,and thereafter annually.Results:1.Comparison of data of TU-LESS(n=72)and vNOTES(n=23)hysterectomy:There was no significant difference in baseline data and uterine volume,adhesion lysis is more common in TU-LESS group(P=0.01).There was no statistically significant difference in such indicators as operation time,conversion rate and intraand post-opetation complication rate,intra-operation bleeding volume,hospitalization stay between the two groups.Patients in vNOTES group showed shorter time to pass gas(P =0.048),shorter time to get back to normal diet(2.26±0.69 days vs 2.81±1.11 days,P=0.03),lower VAS value at 24 h after operation(0(0,1)VS 1(0,2),P =0.03),and lower hospitalization cost(27840.67±4621.47 RMB vs 30560.21±5445.64 RMB,P=0.03).There was no statistically significant difference in vaginal stump recurrence and no patient readmitted within 31 days after operation.2.Comparison of data of TU-LESS(n=59)and vNOTES(n=16)hysterectomy cases with uterine volume less than 12 gestational weeks: There was no significant difference in all data.3.Comparison of data of TU-LESS(n=36)and vNOTES(n=19)hysterectomy cases done by one same surgeon: There was no significant difference in all data.Conclusions:1.The complication rates of TU-LESS and vNOTES hysterectomy are low and not significantly different.Both of them are safe and feasible approaches of hysterectomy.2.vNOTES hysterectomy offered shorter time to pass gas and shorter time to get back to normal diet,making it fitting the concept of enhanced recovery after surgery(ERAS).3.Patients in vNOTES hysterectomy group had a lower VAS value at 24 h after operation.4.There was no significantly different data in cases done by one same surgeon and with uterine volume less than 12 gestational weeks.