Meta-analysis of the efficacy and safety of vaginal natural orifice transluminal endoscopic surgery, laparoscopy, and robot-assisted laparoscopic myomectomy for uterine fibroid removal
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: OBJECTIVES: This study aims to explore the efficacy and safety of vaginal natural orifice transluminal endoscopic surgery (vNOTES), laparoscopy, and robot-assisted laparoscopic myomectomy (RALM) for uterine fibroid removal. MATERIAL AND METHODS: Computer searches were conducted in the Cochrane Library, Embase, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and other databases until May 2023. Randomized controlled trials, cohort studies, case-control studies, and other relevant studies comparing the safety and efficacy of vNOTES, laparoscopy, and RALM for uterine fibroid treatment were included. RESULTS: A total of 28 studies involving 3247 subjects were included. Fifteen studies compared laparoscopy and RALM, thirteen studies compared laparoscopy and vNOTES, and there were no direct comparisons between RALM and vNOTES. In terms of surgical time, vNOTES had significantly shorter surgical time than laparoscopy (MD = 29, 95% CI: 0.89-47) and RALM (MD = 60, 95% CI: 30-90). RALM had significantly shorter surgical time than laparoscopy (MD = -33, 95% CI: -56, -92). There was no significant difference in intraoperative blood loss among the three treatment methods. Regarding hospital stay, vNOTES had a significantly shorter duration than laparoscopy (MD = 0.59, 95% CI: 0.32-0.89) and RALM (MD = 0.51, 95% CI: 0.027-1.00). Laparoscopy had a significantly higher laparotomy rate than vNOTES (OR = 0.27, 95% CI: 0.64-8.4). The rate of postoperative complications was significantly higher in laparoscopy compared to vNOTES (OR = 0.54, 95% CI: 0.23-1.0) and RALM (OR = 0.39, 95% CI: 0.17-0.92). CONCLUSIONS: In patients with uterine fibroids, vNOTES demonstrated significantly shorter surgical time, shorter hospital stay, lower laparotomy rate, and lower rate of postoperative complications compared to laparoscopy. However, vNOTES did not show significant advantages over RALM, except for shorter surgical time.
Source: Ginekologia Polska
DOI: 10.5603/gpl.105224
Authors: Hongyan Yin, Xiaoxian Ren
Institution: Liaocheng People's Hospital
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $431
OpenAlex ID: W4416785291