Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery Versus or Laparoscopic Hysterectomy
NCT ID: NCT05884658
Last Updated: 2024-12-31
Study Results
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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RECRUITING
NA
200 participants
INTERVENTIONAL
2024-12-23
2026-08-31
Brief Summary
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Hysterectomies are performed via 3 routes: laparotomy, laparoscopy or vaginal route.
This choice of approach is particularly important in the case of large uteri (50% of uteri \> 280g), which increase the risks of laparoconversion and bladder injury (NP3).
The vaginal route reduces the operating time and postoperative pain. Laparoscopy allows a better anatomical view and easier access to the neighbouring organs, which makes it the preferred approach, especially for young surgeons and when the uterus is large. However, the laparoscopic route is associated with an increase in the rate of conversion to laparotomy according to the volume of the uterus, as well as the rate of general per and postoperative complications compared with vaginal hysterectomy for uteri \> 280 g. In a meta-analysis comparing laparoscopy and vaginal hysterectomy, the total prevalence of perioperative complications according to the classification of Clavien and Dindo was 27%. For large uteruses, complications by the vaginal route amounted to 15% and those by the laparoscopic route to 37.5%.
The data are not sufficient to give preference to one or other of the approaches, but for benign pathologies, for large uteri (\>280 g), the minimally invasive laparoscopic or vaginal approaches are recommended by the CNGOF (grade C).
A new Medical Device (MD), the vNOTES (Vaginal Natural Orifice Transluminal Endoscopy System) offers the advantage of two approaches for pelvic surgery by allowing minimally invasive surgery to be performed by endoscopy through the vagina, offering perfect vision for the assistants and the operator and without scarring. Two randomized trials have shown that vNOTES allows, compared to laparoscopy, to perform adnexectomies and hysterectomies without conversion with less pain, fewer postoperative complications and a shorter hospitalization time.
The first evaluations of vNOTES are encouraging and suggest a new era for pelvic surgery: less postoperative pain, fewer complications and facilitation of ambulatory care. Also the videoscopic assistance of the vNOTES is a pedagogical tool for the vaginal route because the field of vision is no longer limited to the operator alone. However, the vNOTES has only been evaluated by the developers of the tool, in monocentric studies and in small numbers. The hysterectomy study evaluated only 35 patients with vNOTES, half of whom had a uterus of less than 280 g. The benefit of vNOTES for uteri smaller than 280 g is not obvious because of the ease of the surgical procedure and the cost of the "classic" vaginal route. Our study would be the first multicentric and academic study on vNOTES to focus specifically on large volume uteri, the most difficult to operate and prone to postoperative complications.
Detailed Description
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Conditions
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Keywords
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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laparoscopic hysterectomy
Laparoscopic Hysterectomy will be performed in a standardized manner with or without surgical robot
laparoscopic hysterectomy
laparoscopic hysterectomy uses a standardized procedure with or without surgical robot
natural vaginal orifice transluminal endoscopic system for hysterectomies (vNOTES)
Vaginal hysterectomy will be performed in a standardized manner using transluminal endoscopic system
vNOTES : natural vaginal orifice transluminal endoscopic system for hysterectomies
hysterectomy via the vaginal approach by vNOTES (natural vaginal orifice transluminal endoscopic system for hysterectomies)
Interventions
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vNOTES : natural vaginal orifice transluminal endoscopic system for hysterectomies
hysterectomy via the vaginal approach by vNOTES (natural vaginal orifice transluminal endoscopic system for hysterectomies)
laparoscopic hysterectomy
laparoscopic hysterectomy uses a standardized procedure with or without surgical robot
Eligibility Criteria
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Inclusion Criteria
* Patient affiliated or entitled to a social security system
* Patients over 18 years of age
* Patients having given their agreement to participate and after signing the consent form
Exclusion Criteria
* Non-French speaking woman (unable to conduct a good quality interview of the pregnant woman)
* Participation in another interventional study.
* Patient subject to a legal protection measure or unable to express her consent
18 Years
FEMALE
No
Sponsors
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Ministry of Health, France
OTHER_GOV
Centre Hospitalier Universitaire de Saint Etienne
OTHER
Responsible Party
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Principal Investigators
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Céline CHAULEUR, PhD
Role: PRINCIPAL_INVESTIGATOR
CHU SAINT-ETIENNE
Locations
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HFME - Hospices Civils de Lyon
Bron, , France
CHU Clermont-Ferrand
Clermont-Ferrand, , France
Ch Issoire
Issoire, , France
CHU Saint-Etienne
Saint-Etienne, , France
Clinique Mutualiste de Saint-Etienne
Saint-Etienne, , France
Countries
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Central Contacts
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Facility Contacts
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Géry LAMBLIN
Role: primary
Sandrine CAMPAGNE-LOISEAU, PH
Role: primary
Aslam MANSOOR
Role: primary
Céline CHAULEUR, PhD
Role: primary
Quentin REBOUL, MD
Role: primary
Other Identifiers
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2023-A01013-42
Identifier Type: OTHER
Identifier Source: secondary_id
21PH265
Identifier Type: -
Identifier Source: org_study_id