Comparison Between The Application Of Transvaginal Natural Orifice Transluminal Endoscopic Surgery(vNOTES)and Multiport Laparoscopy In Hysterectomy : A Meta-analysis

Objective:The purpose of this meta-analysis is to evaluate the safety and feasibility of transvaginal natural orifice transluminal endoscopic surgery compared with multiport laparoscopy in treating gynecological benign diseases,and to provide reference for clinical selection.Methods:The databases for searching foreign languages include Pub Med,Embase,Cochrane Library,and Chinese databases include CNKI and Wanfang.The time limit for searching is from the establishment of the database to February 2021.According to the inclusion criteria and exclusion criteria,the literature was selected,and the quality evaluation of literature was based on the quality evaluation form of Neuskar-Ottawa Scale(NOS).Use Review Manager5.3 software for statistical analysis.MD(Mean Difference)and its 95% CI(Confidence Interval)are used for continuous data analysis.OR(Odds Ratio)and its 95% CI were used to analyze the data of dichotomy.If there is no quantitative data or insufficient data,descriptive analysis is adopted;If there are cases where the studies cannot be merged,meta-analysis will be abandoned and only general descriptive analysis will be done.Results:A total of 743 Chinese and English literatures were consulted,which were screened according to the inclusion criteria,and 9 literatures were available,including397 cases in transvaginal natural orifice transluminal endoscopic surgery group and776 cases in multiport laparoscopy group.The meta-analysis results showed that there were no significant difference between the transvaginal natural orifice transluminal endoscopic surgery and conventional laparoscopy in terms of Intraoperative blood loss(MD=-6.55,95%CI[-35.46,22.35],P=0.66),decreased HGB level(MD=0.20,95%CI[-0.01,0.41],P=0.06),surgery trusfusion rate(OR=2.20,95%CI[0.46,10.54],P=0.32),intraoperative complication rate(OR=0.79,95%CI[0.27,2.36],P=0.68),postoperative fever Incidence rate(OR=0.64,95%CI[0.33,1.26],P=0.20)and readmission rate(OR=0.23,95%CI[0.05,1.07],P=0.06).v NOTES group has shorter operation time(MD=-27.82,95%CI [-37.52,-18.12],P<0.00001),hospital stay(MD=-0.37,95%CI[-0.55,-0.20],P<0.0001),and postoperative hospital stay(MD=-0.67,95%CI[-1.27,-0.07],P=0.03)than multiport laparoscopy group;postoperative pain(MD=-0.99,95%CI[-1.74,-0.24],P=0.010)is reduced;postoperative fever is not significantly different,but the total postoperative complications rate(OR=0.48,95%CI[0.27,0.85],P=0.01)is reduced.Conclusion:Transvaginal natural endoscopic hysterectomy is safe and feasible for successful hysterectomy of patients who meet the inclusion criteria.As the transvaginal endoscopic surgery is still in a new stage of development,there are still limitations,the indications for surgery should be reasonable and prudent grasp.Because most of the literature included in this study is cohort studies,a large number of prospective,multicenter,Randomized controlled trial studies are needed in the future.