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935 Vnotes approach for oncological surgery: a review of one centre
  1. Janire Zarragoitia,
  2. Francesc Fargas,
  3. Sonia Baulies,
  4. Francesc Tresserra and
  5. Rafael Fabregas
  1. Dexeus University Hospital, Barcelona, Spain


Introduction/Background Since multiport laparoscopy replaced open surgery, surgeons started looking for ways to innovate. As a result, laparoendoscopic single-site surgery (LESS) emerged. MIS in endometrial and cervical cancer has been associated with improved quality of life, less blood loss, and similar cancer-related outcomes. To further reduce the morbidity and scarring related to laparoscopic surgery, and improve visualization, closure, and healing, the transvaginal natural orifice transluminal endoscopic surgery (vNOTES), has been developed. A series of studies demonstrating the feasibility of vNOTES were conducted in benign gynecologic diseases but have not been confirmed in operations involving malignant tumors. The aim of this study was to evaluate the feasibility of vNOTES surgery for gynaecological cancer, including SLN assessment.

Methodology This is a retrospective and observational study of the period between 2022–2023, including 54 patients with early stages of endometrial/cervical malignancy and premalignancy. They all underwent surgery via vNOTES, 26 of them including SLN assessment.

Results 26 patients underwent bilateral SLNB using ICG +/- Tc99 as tracers followed by total hysterectomy and bilateral salpingooforectomy, except for one case of positive SNL in a cervical cancer patient. The median operative time was 130min and the estimated blood loss 70mL. No intraoperative complications occurred and none of the patients required blood transfusions. Moreover, all surgeries were completed without conversion to laparoscopy except for the cervical cancer patient in which the planned vaginal surgery was stopped and a retroperitoneal paraaortic lymphadenectomy was performed following protocol. The median postoperative hospitalization stay was one night, and we had one postoperative complication as a pelvic hematoma.

Conclusion Our study suggests that vNOTES could be a safe and feasible approach to perform oncological procedures in early stage cervical and endometrial cancer, including the SNLB assessment. However, prospective studies with longer follow-up periods are needed to demonstrate the benefits and oncological outcomes.

Disclosures None.

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