| Objective:To discuss the perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery(V-NOTES)versus transumbilical laparoendoscopic single-site surgery(TU-LESS)in total hysterectomy.To evaluate the safety and feasibility of transvaginal natural orifice transluminal endoscopic surgery in total hysterectomy,and to provide reference for clinical selection.Methods:After confirming the search terms,Chinese and foreign databases were searched respectively,among which foreign databases included:Pubmed,Embase,Cochrane Library,Web of Science,Chinese databases including:China National Knowledge Infrastructure(CNKI)and Wanfang Database.All relevant literatures about transvaginal natural orifice transluminal endoscopic hysterectomy and transumbilical single-port access total laparoscopic hysterectomy published in domestic and foreign databases from the establishment of the database to February 2022 were searched.All kinds of literatures were screened according to the established inclusion and exclusion criteria.The selected literatures were evaluated by the Newcastle-Ottawa(NOS)quality evaluation table,and the statistical analysis was performed by Stata15.1 software.Results:A total of 10 literatures were included,including 9 Chinese literatures and 1 English literature,320 cases in the V-NOTES group and 408 cases in the TU-LESS group.Meta-analysis results showed:1.Comparison of V-NOTES group and TU-LESS group in terms of operation time:WMD(95%CI)value was-6.45(-10.02,-2.88),P=0.000(<0.05),indicating that there is a difference statistically significant,indicating that the V-NOTES group had a shorter operation time.2.Comparison of intraoperative blood loss:WMD(95%CI)value was 1.64(-3.13,6.42)P=0.500(>0.05),indicating that the difference was not statistically significant,it shows that there is no significant difference in intraoperative blood loss between the V-NOTES group and the TU-LESS group.3.Comparison of hemoglobin levels after surgery:WMD(95%CI)value was-0.60(-1.81,0.62)P=0.500(>0.05),indicating that the difference was not statistically significant,it shows that there is no significant difference between the VNOTES group and the TU-LESS group in the decrease of hemoglobin levels after surgery.4.Comparison of postoperative anal exhaust time:WMD(95%CI)value was-9.65(-13.05,-6.24)P=0.000(<0.05),indicating that the difference was statistically significant,indicating that the postoperative exhaust time was earlier in the V-NOTES group.5.Comparison of length of stay in hospital:WMD(95%CI)value was-0.56(-0.69,-0.43)P=0.000(<0.05),indicating that the difference was statistically significant,indicating that the V-NOTES group had a shorter hospital stay.6.Comparison of VAS score at 24 hours after operation:WMD(95%CI)value was-0.36(-0.64,-0.08)P=0.013(<0.05),indicating that the difference was statistically significant,indicating that the postoperative pain in the V-NOTES group is less.7.Comparison of total postoperative complication rates:WMD(95%CI)value was 0.33(0.14,0.79),P=0.012(<0.05),indicating that the difference was statistically significant,indicating that the total postoperative complication rate was less in the V-NOTES group.Conclusions:Based on the included literature,this study demonstrated that transvaginal natural orifice transluminal endoscopic hysterectomy is safe and feasible.Compared with transumbilical single-port access total laparoscopic hysterectomy,the former can shorten the operation time,postoperative exhaust time,hospitalization time,reduce postoperative pain,and reduce the total postoperative complication rate.There was no significant difference in intraoperative blood loss and postoperative hemoglobin drop between the two groups.Due to the small sample size of the literatures included in this study,most of the literatures are cohort studies,and a large number of prospective,multicenter,randomized controlled trials are needed for comparison in the future. |
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