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Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial
Author(s) -
Baekelandt JF,
De Mulder PA,
Le Roy I,
Mathieu C,
Laenen A,
Enzlin P,
Weyers S,
Mol BWJ,
Bosteels JJA
Publication year - 2019
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.15504
Subject(s) - medicine , hysterectomy , laparoscopy , randomized controlled trial , natural orifice transluminal endoscopic surgery , surgery , blinding , clinical endpoint
Objective To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery ( vNOTES ) versus total laparoscopic hysterectomy ( TLH ) as a day‐care procedure. Design Parallel group, 1:1 randomised single‐centre single‐blinded trial, designed as a non‐inferiority study with a margin of 15%. Setting Belgian teaching hospital. Population Women aged 18–70 years scheduled to undergo hysterectomy for benign indications. Methods Randomisation to TLH (control group) or vNOTES (experimental group). Stratification according to uterine volume. Blinding of participants and outcome assessors. Main outcome measures The primary outcome was hysterectomy by the allocated technique. We measured the proportion of women leaving within 12 hours after hysterectomy and the length of hospital stay as secondary outcomes. Results We randomly assigned 70 women to vNOTES ( n = 35) or TLH ( n = 35). The primary endpoint was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the TLH group: the one‐sided 95% upper limit for the differences in proportions of conversion was estimated as 7.5%, which is below the predefined non‐inferiority margin. More women left the hospital within 12 hours after surgery after vNOTES : 77 versus 43%, difference 34% (95% CI 13–56%), P = 0.007. The hospital stay was shorter after vNOTES : 0.8 versus 1.3 days, mean difference −0.5 days, (95% CI −0.98 to −0.02), P = 0.004. Conclusions vNOTES is non‐inferior to TLH for successfully performing hysterectomy without conversion. Compared with TLH , vNOTES may allow more women to be treated in a day‐care setting. Tweetable abstract RCT : vNOTES is just as good as laparoscopy for successful hysterectomy without conversion but allows more day‐care surgery.