Surgeons practices and attitudes in surgeons performing vNOTES hysterectomies

Objectives: The objective of the study is to investigate practices and attitudes in surgeons performing vNOTES hysterectomies.

Methods: A 22-item online survey was created to assess surgeon demographics, practices performing transvaginal natural orifice transendoscopic surgeries – hysterectomies. We also evaluated different practices associated with vaginal cuff closure including suspension of the vagina and universal cystoscopy.

Results: The survey was distributed using the Qualtrics platform. Fifty-four surgeons opened the survey, one declined to participate and one had incomplete data which was not included for the final analysis. Twenty-nine surgeons (55.8%) identified as female and 23 identified as male (44.2%). The majority of surgeons (86.5%) were practicing in the United States, with the remaining seven surgeons distributed between Antigua, Belgium, Kenya, Mexico, Spain, Sweden & Turkey. In addition to standard hysterectomy, the survey specifically evaluated vaginal support procedures. Of the participants, 53.8% of the surgeons perform a suspension procedure to the vaginal cuff regardless of if the patient has prolapse or not. The most popular suspension procedure was to incorporate the uterosacral ligaments to the vaginal cuff (39.3%) followed by a high-uterosacral ligament suspension (35.7%) and a McCalls culdoplasty (25%). Universal cystoscopy was performed by 58.6% of the surgeons.

Conclusions: Surgeons reported having similar techniques and practices to perform vNOTES hysterectomies. The iNOTES society has promoted the standardization of vNOTES hysterectomies to improve outcomes. Variations in performing surgeries is expected and probably correlates to geographical regions, level of training and available resources. More research is needed to determine best practices and outcomes.