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Adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery versus laparoscopy: results of a first randomised controlled trial (NOTABLE trial).
Baekelandt, J; De Mulder, P A; Le Roy, I; Mathieu, C; Laenen, A; Enzlin, P; Morlion, B; Weyers, S; Mol, Bwj; Bosteels, Jja.
Afiliación
  • Baekelandt J; Department of Gynaecology, Imelda Hospital, Bonheiden, Belgium.
  • De Mulder PA; Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven-University of Leuven, Leuven, Belgium.
  • Le Roy I; Department of Anaesthesiology, Imelda Hospital, Bonheiden, Belgium.
  • Mathieu C; Department of Anaesthesiology, Imelda Hospital, Bonheiden, Belgium.
  • Laenen A; Department of Clinical and Experimental Medicine, Clinical and Experimental Endocrinology, KU Leuven-University of Leuven, Leuven, Belgium.
  • Enzlin P; Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven-University of Leuven, Leuven, Belgium.
  • Morlion B; Department of Neurosciences, Interfaculty Institute for Family and Sexuality Studies, KU Leuven-University of Leuven, Leuven, Belgium.
  • Weyers S; Department of Cardiovascular Sciences, Section Anaesthesiology & Algology, KU Leuven-University of Leuven, Leuven, Belgium.
  • Mol B; Universitaire Vrouwenkliniek, University Hospital Gent, Gent, Belgium.
  • Bosteels J; Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia.
BJOG ; 128(11): 1782-1791, 2021 10.
Article en En | MEDLINE | ID: mdl-34246198
OBJECTIVE: To compare adnexectomy by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) versus laparoscopy. DESIGN: Parallel group, 1:1 single-centre single-blinded randomised trial, designed as non-inferiority study with a margin of 15%. SETTING: Belgian teaching hospital. POPULATION: Non-pregnant non-virgin women with an intact uterus and without obliteration of the pouch of Douglas scheduled to undergo removal of an adnexal mass assessed to be benign on ultrasound by IOTA criteria. METHODS: Randomisation to laparoscopy (control group) or vNOTES (experimental group). Stratification according to adnexal size. Blinding of participants and outcome assessors by sham incisions. MAIN OUTCOME MEASURES: The primary outcome measure was adnexectomy by the allocated technique. Secondary outcomes included duration of surgery, pain scores and analgesics used, quality of life and adverse events. RESULTS: We randomly assigned 67 participants (34 to the vNOTES group and 33 to the laparoscopy group). The primary end point was always reached in both groups: there were no conversions. We performed a sensitivity analysis for the primary outcome, assuming one conversion in the vNOTES group and no conversions in the laparoscopy group: the one-sided 95% upper limit for the differences in proportions of conversion was estimated as 13%, which is below the predefined non-inferiority margin of 15%. The secondary outcomes demonstrated a shorter duration of surgery, lower pain scores, lower total dose of analgesics and a trend for more adverse events in the vNOTES group. CONCLUSIONS: vNOTES is non-inferior to laparoscopy for a successful adnexectomy without conversion. vNOTES allowed shorter operating times and less postoperative pain but there was a trend for more adverse events.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vagina / Anexos Uterinos / Enfermedades de los Anexos / Laparoscopía / Cirugía Endoscópica por Orificios Naturales Tipo de estudio: Clinical_trials / Etiology_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Middle aged Idioma: En Revista: BJOG Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2021 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Vagina / Anexos Uterinos / Enfermedades de los Anexos / Laparoscopía / Cirugía Endoscópica por Orificios Naturales Tipo de estudio: Clinical_trials / Etiology_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Middle aged Idioma: En Revista: BJOG Asunto de la revista: GINECOLOGIA / OBSTETRICIA Año: 2021 Tipo del documento: Article País de afiliación: Bélgica Pais de publicación: Reino Unido