Study Objective: To review our experience with low-grade endometrial
cancer managed with vaginal natural orifice transluminal endoscopic
surgery (vNOTES) to determine the feasibility of this approach. Design:
Retrospective review of the first fifty cases of endometrial cancer
treated by vNOTES Setting: Academic University Population: Fifty
consecutive cases of vNOTES management of women with low-grade
endometrial cancer were reviewed to detail patient characteristics,
operative procedures and outcomes, complications and follow-up. Methods:
Patients underwent vNOTES hysterectomy and bilateral
salpingo-oophorectomy. If Mayo criteria for lymphadenectomy were met, a
laparoscopic lymph node removal was performed. Main Results: Mean age
was 63 (33-90); mean BMI was 35.4 (22-58). In 44 women, both tubes and
ovaries were removed via vNOTES. Three women had their ovaries retained
due to early age, one woman had exploration for removal of an ovary with
metastatic disease, and two women had neither tubes nor ovaries removed
due to atresia and inability to identify these organs. Two patients
underwent laparoscopic lymphadenectomy on the bases of frozen section
evaluation. Mean operative time was 98 minutes (30-215). Fourteen
patients were discharged the day of surgery; 34 discharged after
overnight observation; hospitalization was prolonged in one patient due
to ileus and one patient underwent laparotomy 30 hours after vNOTES for
bleeding. Conclusion: VNOTES is a feasible management strategy for women
with low-grade endometrial cancer. It permits laparoscopic inspection of
the abdomen and direct visualization of vascular pedicles. It can
provide a rapid recovery with minimal discomfort and no visible scar.
Natural orifice transvaginal endoscopic surgery for endometrial cancer
