vNOTES Hysterectomies as a Challenge for Current Guidelines Regarding Benign Disease [ID 1556]

INTRODUCTION: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) emerged as a modern technique, providing better visibility to pelvic structures. The American College of Obstetrics and Gynecologists recommends the vaginal approach as the gold standard for hysterectomies with benign indications. This study evaluates vNOTES hysterectomies (vNOTES-H) and compares outcomes to those of vaginal and total laparoscopic approaches. METHODS: Women older than 21 years with a scheduled vNOTES-H, vaginal hysterectomy (VH), or total laparoscopic hysterectomy (TLH) were recruited at the University of Puerto Rico and Oasis Women Medical Center. Data was gathered from record reviews and interviews. PROMIS measures evaluated pain interference and physical function on day 1 (±2), 7 (±2), and 42 (±2). Descriptive statistics and standardized T-scores (T) were employed for analysis. RESULTS: Mean age was 54 (±2) (n=42). Most common indication for surgery was abnormal uterine bleeding (24, 57.1%). No major complications were reported. vNOTES-H obtained the lowest average blood loss (ABL 120 mL). PROMIS measures revealed that women with vNOTES-H had less pain interference on days 1 (T=59.6) and 7 (T=53.5) yet scored equal to VH on day 42 (T=47.8). Women with vNOTES-H and VH reported better physical function on days 1 (T=40.4; 40.3), 7 (T=44.4; 45.0), and 42 (T=50; 50), as compared to TLH counterparts. CONCLUSIONS/IMPLICATIONS: Findings suggest vNOTES-H presents a novel alternative to VH. Women subjected to vNOTES-H could benefit from the same outcomes granted by VH with a lower risk for injury. vNOTES-H potentially challenges guidelines given its modern advances. Further research is vital for characterizing the novel technique.