vNOTES Hysterectomy with Sentinel Lymph Node Mapping for Endometrial Cancer: Description of Technique and Perioperative Outcomes.

Abstract

STUDY OBJECTIVES\nTo explore the technique and clinical value of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in hysterectomy and sentinel lymph node (SLN) mapping for endometrial cancer by comparing its perioperative outcomes with those of laparoscopic staging.\n\n\nDESIGN\nRetrospective cohort study.\n\n\nSETTING\nDepartment of Gynecology in a tertiary medical center.\n\n\nPATIENTS\nAll women diagnosed with endometrial cancer who underwent minimally invasive surgery at our center between 2017 and 2020.\n\n\nINTERVENTIONS\nBoth vNOTES and laparoscopic approaches were used for hysterectomy and SLN mapping. The success of SLN detection and perioperative outcomes were subsequently analyzed.\n\n\nMEASUREMENT AND MAIN RESULTS\nThis study included 74 patients; 23 patients underwent vNOTES surgery, while 51 underwent standard laparoscopic surgery. The total successful SLN detection was 95.7% in the vNOTES group and 92.2% in the laparoscopic group (p>0.05), while the bilateral success rates were 87.0% and 90.2%, respectively. No difference in SLN detection was observed between the two groups in terms of the side-specific mapping efficacy quotient (91.3% vs. 91.2%, P=0.47). The number of harvested SLNs, operative time, estimated blood loss and intraoperative complications in the two groups were similar. One (4.3%) postoperative complication occurred in the vNOTES group versus 4 (7.9%) in the laparoscopy group (p=0.029), and the median postoperative hospital stay was three days versus four days (p=0.003).\n\n\nCONCLUSIONS\nThis study suggests that the vNOTES procedure is feasible, with a potentially decreased postoperative hospital stay, faster recovery, and better cosmetic results. However, prospective research is needed to validate its broader clinical application.