Vaginal transluminal endoscopic hysterectomy and adnexal surgery for benign gynaecological conditions

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 1 systematic review (of 1 randomised controlled trial and 5 retrospective studies), 1 randomised controlled trial, 2 prospective case series and 5 retrospective cohort studies. It is presented in the summary of key evidence section in the overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcome to be: procedure success.

The professional experts and the committee considered the key safety outcomes to be: pain, bleeding, infection, organ injury, vaginal prolapse, and dyspareunia.

There were 48 responses from people who have had this procedure, which were discussed by the committee.

Clinical experts emphasised the importance of additional research. Concerns were expressed about the generalisability of study results from high-volume centres to smaller practices. To gain a deeper understanding of this procedure's outcomes, the committee encourages further research through well-designed, suitably powered randomised controlled trials, or the use of registry data and audits.

The committee was informed that contraindications to this procedure include, but are not limited to, some forms of pelvic inflammatory disease, endometriosis and previous surgery or radiotherapy.

The committee noted that there are multiple methods and ports to do this procedure.

It is important that further evidence is captured on patient selection and long-term outcomes (particularly vaginal prolapse).

The committee was informed that this procedure is of particular benefit to people with a high BMI or a history of bowel surgery (for example, colectomy). This is because of improved operative function and view compared with laparoscopic surgeries.