ObjectiveTo present the rates of intra‐ and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.DesignInternational register‐based cohort study.SettingHysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.Population4565 patients undergoing vNOTES hysterectomy.MethodsDescriptive data are presented in frequencies (n) and percent (%).Main Outcome MeasureIntra‐ and postoperative complications. Conversions.ResultsIntraoperative and postoperative complication rates were 3.2% (n = 144) and 2.5% (n = 115), respectively. Conversions occurred in 1.6% (n = 72), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (n = 28), vault complications (n = 26) including 11 infected vault hematomas, cystitis (n = 18) and non‐specific infections (n = 14). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.ConclusionsThe largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra‐ and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.

中文翻译：

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4565 例 vNOTES 子宫切除术的术中和术后并发症：国际注册队列研究


目的介绍由具有不同专业知识水平的外科医生进行的一大组未经选择的 vNOTES 子宫切除术中和术后并发症和转换的发生率。Design国际注册的队列研究。2015 年至 2024 年 1 月在 iNOTESs 登记处进行子宫切除术，由来自多个国家的 201 名外科医生进行。人群4565 名接受 vNOTES 子宫切除术的患者。方法描述性数据以频率 （n） 和百分比 （%） 表示。主要结局指标术中和术后并发症。结果术中和术后并发症发生率分别为 3.2% （n = 144） 和 2.5% （n = 115）。1.6% （n = 72） 发生转化，其中 10 例 （0.2%） 发生剖腹手术，82% 的转化发生在外科医生学习曲线的前 50 例病例内。最常见的术中并发症是膀胱切开术，发生率为 1.3%，几乎一半是由没有经验的外科医生进行的。其他术中器官损伤发生 20 例 （0.44%）。术后最常见的并发症是出血 （n = 28）、穹窿并发症 （n = 26），包括 11 例感染性穹窿血肿、膀胱炎 （n = 18） 和非特异性感染 （n = 14）。vNOTES 子宫切除术由 201 名外科医生进行，其中 9.5% 进行了 50 多例 vNOTES 病例，占登记病例的 70%。其余 30% 的子宫切除术主要代表来自 90% 纳入外科医生的学习曲线数据。并发症发生率随着手术经验的增加而降低。结论介绍了最大的 vNOTES 子宫切除术研究人群，包括学习曲线数据和来自经验丰富的外科医生的数据，术中和术后并发症的发生率可接受。未发现 vNOTES 劣于其他微创方法。