Hysterectomy for post‑cesarean peritoneal adhesions in obese patients
Musin I.I., Berg E.A., Yashchuk A.G., Kolodyazhnaya E.A., Nasyrova S.F., Popova E.M., Molokanova A.R., Khannanov A.R.
In this article, we discuss the experience and effectiveness of endoscopic hysterectomy using a vaginal natural orifice transluminal endoscopic surgery (vNOTES) in obese patients with post-cesarean peritoneal adhesions. Performing surgery through the vagina combines the advantages of transvaginal and laparoscopic surgery, making it a potentially preferred option for patients with somatic comorbidities and a complicated obstetric and gynecological history.
Objective: To describe and illustrate the experience of performing vNOTES in obese patients undergoing hysterectomy for post-caesarean peritoneal adhesions.
Materials and methods: The authors present their experience with vNOTES for hysterectomy in 19 patients aged 42–57 years with recurrent endometrial hyperplasia, concomitant obesity, and post-cesarean pelvic adhesions. This study was conducted at the clinical facilities of the Department of Obstetrics and Gynecology No. 2 of the Bashkir SMU, Ministry of Health of Russia.
Results: The advantages of vNOTES for hysterectomy in obese patients with post-cesarean peritoneal adhesions compared with traditional laparoscopic surgery include reduced risk of trocar-related complications (which increase with obesity and the presence of peritoneal adhesions), reduced risk of postoperative complications associated with an anterior abdominal wall incision, less blood loss, better cosmetic effect due to the absence of additional abdominal wall incisions, less pain, early activation, rapid recovery, and quicker return to daily activities.
Conclusion: The vNOTES technology for hysterectomy in obese patients with post-cesarean peritoneal adhesions proves to be a minimally invasive, effective, and practical approach to surgical management in this patient population. It combines the advantages of both vaginal and laparoscopic procedures, with low blood loss and minimal intra- and post-operative complications. The benefits associated with improved visualization, increased maneuverability during manipulation, and low conversion rate make it a compelling alternative to other minimally invasive surgical approaches. However, further large-scale, multicenter, prospective, randomized controlled trials are necessary to establish clear indications and contraindications and to evaluate the efficacy, safety, and long-term outcomes of this method.
Authors' contributions: Musin I.I. – conception and design of the study, material collection; Berg E.A. – drafting of the manuscript, statistical analysis, material collection; Yashchuk A.G. – conception of the study, drafting of the manuscript, final approval for submission; Kolodyazhnaya E.A., Khannanov A.R. – material collection; Nasyrova S.F. – drafting of the manuscript, editing of the manuscript; Popova E.M., Molokanova A.R. – statistical analysis.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the Bashkir SMU of Minzdrav of Russia.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Musin I.I., Berg E.A., Yashchuk A.G., Kolodyazhnaya E.A., Nasyrova S.F., Popova E.M., Molokanova A.R., Khannanov A.R. Hysterectomy for post-cesarean peritoneal adhesions in obese patients.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (9): 81-89 (in Russian)
https://dx.doi.org/10.18565/aig.2024.143
Keywords
hysterectomy
vNOTES
obesity
peritoneal adhesions
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Received 19.06.2024
Accepted 02.08.2024
About the Authors
Ilnur I. Musin, Dr. Med. Sci., Professor at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,450008, Russia, Ufa, Lenin str., 3, +73472649650, ilnur-musin@yandex.ru, https://orcid.org/0000-0001-5520-5845
Alfiya G. Yashchuk, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia, 450008, Russia, Ufa, Lenin str., 3, +73472649650, alfiya_galimovna@mail.ru, https://orcid.org/0000-0003-2645-1662
Elena A. Kolodyazhnaya, Clinical Resident at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin st., 3, +79174218784, elena_l_a@list.ru, https://orcid.org/0000-0001-5133-7293
Edvard A. Berg, PhD, Associate Professor at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +79273379003, nucleardeer@mail.com, https://orcid.org/0000-0002-2028-7796
Svetlana F. Nasyrova, PhD, Associate Professor at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +73472649650, ufa863@mail.ru, https://orcid.org/0000-0002-2313-7232
Elena M. Popova, Teaching Assistant at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +79871335969, kafedraagidpo2@mail.ru, https://orcid.org/0000-0001-7298-3489
Angela R. Molokanova, PhD student at the Department of Obstetrics and Gynecology №2, Bashkir State Medical University, Ministry of Health of Russia,
450008, Russia, Ufa, Lenin str., 3, +79297557755, angella1210@mail.ru, https://orcid.org/0000-0003-1115-6775
Arslan R. Khannanov, 4th year student of the Faculty of Dentistry, Bashkir State Medical University, Ministry of Health of Russia, 450008, Russia, Ufa, Lenin str., 3, +73472649650, arslan1804@yandex.ru, https://orcid.org/0009-0009-5974-8420
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