VNOTES (Vaginal Natural Orifice Transluminal Surgery) Gynecologic Procedures in Morbidly and Super-morbidly Obese Women: Five Year Experience for Three Surgeons

Abstract

Abstract Purpose To analyze our experience with vNOTES gynecologic procedures in women with morbid and super morbid obesity. Methods Gynecologic procedures performed by three surgeons on women with a body mass index (BMI) ≥ 40 kg/m2 from 2017 to 2023. A subset of women with a BMI ≥ 50 kg/m2 were also analyzed. Results 103 women with a BMI ≥ 40kg/m2 were identified, 19 of whom had a BMI ≥ 50 kg/m2. For the entire population the mean BMI was 45.7 kg/m2 (40–62). 29 women were nulliparous and 23 had at least one prior cesarean delivery. 51 had no prior abdominal surgery. The procedures performed were hysterectomy and removal of adnexae in 77 patients, hysterectomy alone in six, adnexal surgery alone in nine, and hysterectomy with adnexectomy and lymph nodes in five. Two surgeries were converted to laparoscopy and five to laparotomy. Average surgical time was 87 minutes (30–232). Average blood loss was 82 mL (10–400). Mean uterine weight was 206 g (29-2890). 53 procedures were performed as outpatient, 44 had overnight observation, four had a length of stay of two days, one each for four days and five days. The laparoscopies occurred in one patient with an obliterated cul-de-sac and in one patient for lymph node removal. The laparotomies occurred for adnexal adhesions in one, bleeding in two, a cystotomy in one requiring urology consultation, and an obliterated cul-de-sac One patient developed a postoperative vaginal cuff hematoma not requiring intervention. Conclusion vNOTES gynecologic procedures are feasible in this high-risk population and may result in shorter recovery times and fewer complications than standard laparoscopy or laparotomy.