Procedural considerations of hysterectomy by vNOTES (vaginal natural orifice transluminal endoscopic surgery): A literature review

Abstract

Problem identification: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a modernised vaginal approach that combines the benefits of laparoscopic and traditional vaginal surgery techniques. The aim of this review is to look at vNOTES through a perioperative nursing lens, focusing on providing greater understanding and knowledge for perioperative nurses.

Literature search: An electronic database search of EBSCO, CINAHL, Medline, PubMed and Scopus delivered 16 articles for inclusion in this literature review. The papers included were eight retrospective observational studies, five randomised control trials and three systematic reviews and meta-analyses that compared 1961 vNOTES hysterectomy procedures with 2161 conventional laparoscopic hysterectomy procedures.

Data evaluation synthesis: The vNOTES hysterectomy approach has three phases: phases one and three are vaginal entry and phase two is via laparoscopic entry. Four procedural considerations for vNOTES are anaesthesia and pre-operative preparation, surgical skin preparation and draping, equipment and furniture, and instrumentation and consumables. Some benefits of the vNOTES hysterectomy approach are lower levels of post-operative pain, shorter hospitalisation and reduced incidence of intraoperative and post-operative complications. However, it is also important to acknowledge some drawbacks in terms of restricted access, reduced manoeuvrability and limited visualisation when evaluating the suitability of vNOTES hysterectomy as an alternative to conventional laparoscopic
hysterectomy.

Implications for perioperative nursing practice or research: The vNOTES hysterectomy procedure holds promise for enhanced patient care. Perioperative nurses’ involvement in new, innovative, minimally invasive procedures like vNOTES hysterectomy will require understanding and knowledge. Perioperative nurses’ familiarity with and knowledge of patient positioning, patient monitoring, surgical technique and intra-operative support, makes them valuable team members during the introduction of the vNOTES approach. This review will allow perioperative nurses to gain knowledge prior to the possible introduction of the vNOTES approach in their
theatres, thus empowering them to contribute effectively to patient safety, comfort and positive outcomes.