Hysterectomy for post-cesarean peritoneal adhesions in obese patients

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.