Procedure leading to faster recovery for hysterectomy patients may reverse decline in vaginal hysterectomies

Editor's Note

This recent study published in early 2023 by the Journal of the Society of Laparoscopic & Robotic Surgeons highlights that the total number of benign hysterectomies being performed in the US has decreased, with vaginal hysterectomies declining by 19% over 2 years. Only 12% of hysterectomies for benign indications are done vaginally, while 66% are done laparoscopically or robotically. Despite guidelines that advocate for the vaginal route for benign hysterectomy when feasible, the study authors pose that current practice seems to be moving away from this recommendation.

In the study, the decline in rates of vaginal hysterectomies is attributed to factors such as:

• the emergence of laparoscopic and robotic surgery
• limited training opportunities for vaginal surgery
• the global perception that views laparoscopic procedures as being less complicated overall.

The study puts forth the innovative procedure called vNOTES—or vaginal natural orifice transluminal endoscopic surgery—as potentially reversing the decline in the number of vaginal hysterectomies being performed. vNOTES is a surgical approach that uses the vagina to access the abdominal cavity for various procedures including hysterectomy, uterosacral ligament suspension, and adnexal surgeries. The technique is a modification of laparoendoscopic single-site surgery (LESS) and NOTES (natural orifice transluminal endoscopic surgery) that involves making a circumferential incision in the vagina before a specialized vNOTES port is used for less invasive instrumentation and lower insufflation pressure.

The authors propose vNOTES as a potential solution to reinvigorating vaginal surgery by discussing clinical scenarios where the approach could be converted from laparoscopic or robotic cases to the vNOTES route. The emergence of vNOTES could offer benefits to both younger surgeons accustomed to laparoscopic techniques and older surgeons looking to acquire new skills, and it may contribute to reversing the decline in vaginal hysterectomy rates and lead to future innovation and advances in gynecological surgery, they conclude.

According to an August 16 article from Henry Herald, vNOTES has recently been added as a minimally invasive option for hysterectomy procedures to patients at Piedmont Henry Hospital and the surrounding area in Georgia. The Piedmont Henry staff expect this advanced technique to provide “many benefits to female patients, such as a shorter hospital stay, less postoperative pain, no visible scars, and a faster recovery time.” The American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists “have recommended vaginal hysterectomy, whenever feasible, as the approach of choice,” noted the article.