(Poster 154) vNOTES vs Conventional Colpopexy Ouctomes: National Study and Literature Review

Objectives: 1) Describe the rates of different routes of minimally invasive apical suspension (AS) procedures in the United States from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database, 2) to compare perioperative complications of vNOTES to other minimally invasive AS, and 3) to review prior comparative literature.

Methods: This research was designated exempt by The University of Texas Health Science Center Institutional Review Board (HSC-MS-24-0644).
Data on female patients with benign diagnoses undergoing vNOTES, robotic, laparoscopic, and vaginal AS in 2022 from the NSQIP database were used to perform a retrospective cohort study (Figure 1). Demographic variables, operative factors, inpatient status, and complication types were collected and stratified by surgical route. The student’s t test or Wilcoxon rank-sum test was used for continuous variables. For categorical variables, Chi-square test or Fisher’s exact tests was used. A multivariable logistic regression was performed to examine the association between the primary outcome (composite complications) and AS route while adjusting for significant demographic and operative variables.
PubMed and ClinicalKey were used to conduct a comprehensive literature search. 884 publications were identified, and 536 were included in initial screening. 32 publications mentioned vNOTES AS and were assessed for eligibility. 7 studies were finally included. From the selected studies, we collected data on study design, patient demographics, operative factors, and complications.

Results: Minimally invasive apical suspension procedures were performed as follows: 37.1% robotic, 36.7% laparoscopic, 21.3% vaginal, and 4.9% as vNOTES. After multivariate adjustments of the NSQIP data, there were no significant differences in perioperative composite morbidity with vNOTES when compared to the other routes of surgery, with composite complication rates between 4.28 and 6.21 percent (Figure 2). Operative time for Vaginal AS was shorter at 125 [87-173] minutes, followed by vNOTES at 134 [84-191], laparoscopic at 146 [103-199], and robotic at 172 [129-231]. Hospital length of stay was significantly shorter with vNOTES AS (n=0) than with the other routes (n=1).
Of the 7 studies included in the literature review (639 patients total), none were performed in the United States. 3 compared vNOTES and laparoscopic AS, while 4 compared vNOTES and vaginal AS. There were no significant differences in blood transfusion rates, postoperative complications, wound complications, urinary tract infections (UTI), reoperation, or surgical cost. The studies gave mixed results regarding differences in operative time, estimated blood loss, hospitalization, and intraoperative complication rates.

Conclusions: When compared with more commonly used routes of AS, vNOTES demonstrated similar complication rates. Our findings support those of international studies noted in our literature review.