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VANH Achieves Higher Same-Day Discharge Rates Than Standard Vaginal Hysterectomy in RCT
In a randomised controlled trial of 113 women, vaginal assisted NOTES hysterectomy (VANH) produced significantly higher same-day discharge rates than conventional vaginal hysterectomy (87.3% vs 71.4%), representing nearly three times the odds of going home the same day (OR 2.76, 95% CI 1.04–7.25). VANH also demonstrated shorter operative times and markedly reduced intraoperative blood loss, without a corresponding increase in complications or differences in recovery or quality of life.
What Was Studied
This trial investigated whether Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery hysterectomy (VANH) could outperform conventional vaginal hysterectomy (VH) as a day-care surgical procedure. The primary question was whether VANH would achieve higher rates of same-day discharge (SDD), a clinically meaningful outcome reflecting patient recovery speed, procedural efficiency, and healthcare resource utilisation.
How It Was Studied
This was a single-blind, multicentre randomised controlled trial conducted across two non-academic Dutch teaching hospitals. Women aged 18 years or older undergoing hysterectomy for benign indications were eligible for enrolment. Participants were randomised in a 1:2 ratio to either VH or VANH, yielding 42 women in the VH arm and 71 in the VANH arm, for a total analysed population of 113. All analyses were conducted on an intention-to-treat basis. Secondary outcomes assessed alongside SDD included operative duration, blood loss, elective salpingectomy rates, intraoperative and postoperative complications graded by Clavien-Dindo criteria, pain scores using a numerical rating scale (NRS), analgesic consumption, postoperative recovery (RI-10), and quality of life (EQ-5D-5L).
What Was Observed
- Same-day discharge was achieved significantly more often with VANH than VH (87.3% vs 71.4%), corresponding to roughly 2.8 times the odds of same-day discharge in the VANH group (OR 2.76, 95% CI 1.04–7.25; p = 0.04). The confidence interval is relatively wide, suggesting some imprecision in the magnitude of this effect, but the direction is clearly in favour of VANH.
- Operative time and blood loss were both significantly lower with VANH. Median surgical duration was 55 minutes for VANH compared to 65 minutes for VH (p = 0.005), and median intraoperative blood loss was three times lower with VANH (50 mL vs 150 mL; p < 0.001), indicating a meaningful intraoperative advantage.
- Elective opportunistic salpingectomy was performed in all VANH cases (100%) versus only 77.4% of VH cases (p = 0.008), suggesting VANH more reliably accommodates this additional prophylactic procedure during the same operative episode.
- Complication rates, readmission, recovery, and quality of life did not differ significantly between groups. Postoperative complications occurred in 9.5% of VH patients and 15.5% of VANH patients (p = 0.34), and readmission rates were 4.8% vs 8.5% respectively (p = 0.47), indicating no statistically detectable safety disadvantage with VANH.
Why This Matters
Same-day discharge following hysterectomy represents a significant logistical and patient-centred goal, and this trial demonstrates that VANH — a more technically advanced approach — can facilitate this outcome more reliably than conventional VH. The finding that VANH also enables universal elective salpingectomy is notable, as this procedure can be performed without added complications, expanding the clinical value of the operative episode. Together, these results suggest VANH may offer a meaningful refinement in surgical approach for women undergoing hysterectomy for benign conditions in centres where NOTES capabilities are available.
How to Read This Result
While the overall direction favours VANH, this is a moderately sized single-country trial with unequal randomisation conducted at only two non-academic centres, and the key primary outcome rests on a confidence interval that only narrowly excludes the null (95% CI 1.04–7.25), meaning the true effect size could be considerably more modest; replication in larger, more diverse populations would strengthen confidence in these findings.
Limitations
The abstract does not explicitly report study limitations.