1 Recommendations

Guidance

1.1 Vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wanting to do vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions should:

Inform the clinical governance leads in their healthcare organisation.
Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Take account of NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.

1.3 Healthcare organisations should:

Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.

1.4 Patient selection should be done by a multidisciplinary team including clinicians with specific training in patient selection and the procedure.

1.5 This procedure should only be done by an experienced surgeon and theatre team with specific training in this procedure (which may include mentoring) and the ability to convert it to a conventional hysterectomy if needed.

1.6 NICE encourages further research into vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions and may update the guidance on publication of further evidence.

Why the committee made these recommendations

Evidence is limited on the safety and efficacy of vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions. Although the evidence includes 1 high-quality randomised controlled trial for each of hysterectomy and adnexectomy, the rest of the evidence is lower quality. This is because most of the studies are retrospective (they examine evidence that is already available about the procedure), and all studies only include short-term outcomes. Given the high number of hysterectomy and adnexal procedures done in the NHS, further evidence is needed to better understand long-term safety and which patients this procedure will work best for.