- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04886791
Vaginal NOTES Hysterectomy Versus Vaginal Hysterectomy (VANH)
Vaginal Hysterectomy Versus Vaginal Assisted NOTES Hysterectomy (VANH): a Randomised Controlled Trial
Rationale: Natural orifice transluminal endoscopic surgery (NOTES) is a minimal invasive technique using the natural body orifices like stomach, oesophagus, bladder, rectum and vagina to access the human body for surgery. In 2012, the first vaginal NOTES (vNOTES) hysterectomy was performed. Potential benefits of vNOTES hysterectomy, also called the vaginal assisted NOTES hysterectomy (VANH) are no visible scars, less pain and a shorter hospital stay compared with laparoscopic hysterectomy as shown in the HALON trial. Up to now, no studies have compared the vNOTES hysterectomy with vaginal hysterectomy.
Objective: The aim of this study is to compare the vNOTES hysterectomy with the vaginal hysterectomy for same day-discharge (SDD), complications, treatment related outcomes, post-operative recovery, quality of life and cost-effectiveness.
Study design: The study concerns a single-blinded, multicentre, randomised controlled trial.
Study population: Eligible women who fulfill the inclusion criteria and will undergo a hysterectomy for benign indication.
Intervention: The study population will be randomly allocated to the VANH-group, who undergo a vaginal assisted NOTES hysterectomy (intervention group) or the vaginal hysterectomy group (control-group) and the participants will be single blinded. The pre- and postoperative care will be the same for both groups.
Main study parameters/endpoints: Primary outcome is the percentage of patients that underwent the hysterectomy as in SDD setting. A total of 41 patients should be included in the control group and a total of 83 patients in the intervention group, using an enrollment ratio of 1:2, with an alpha of 0.05 and a power of 0.8.
The secondary outcomes are complications, treatment related outcomes, post-operative recovery, quality of life and cost-effectiveness.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness:
vNOTES is a new surgical technique, but a combination of two existing techniques namely the vaginal hysterectomy and the laparoscopic hysterectomy. Only one randomized controlled trial has been published, comparing the total laparoscopic hysterectomy (TLH) with the VANH, which shows no inferiority of the vNOTES technique compared to a laparoscopy. A recent case series study has been published about the complication rate in VANH. There was a total complication rate in the hysterectomy group of 5.2%, in which 1.4% was intra-operative and 3.8% postoperative. Theoretically it is possible that the VANH causes less intra-operative complications because of an improved view during the procedure. No further literature is known about VH versus VANH. Participants of the study should fill in multiple questionnaires before randomization and postoperative about their general health, pain experience and used analgesics.
Study Overview
Status
Intervention / Treatment
Detailed Description
The hysterectomy is one of the most performed gynaecological surgeries worldwide.
In the Netherlands about 14.500 hysterectomies are performed yearly. The most common benign indications to perform a hysterectomy are abnormal uterine bleeding, uterine leiomyomas, endometriosis or adenomyosis, chronic pelvic pain, uterine prolapse, benign ovarian neoplasm, hyperplasia or atypia of the endometrium or cervical dysplasia.
The four approaches to perform a hysterectomy for benign disease are abdominal hysterectomy (AH), vaginal hysterectomy (VH), (total) laparoscopic hysterectomy ((T)LH) and robotic-assisted hysterectomy (RH).
VH appears to be superior to the AH, resulting in a quicker recovery. The LH results in a quicker recovery than the AH and VH, but increases the risks of damage to the bladder or ureter. That is why a recent Cochrane review advises to perform a VH when feasible for women undergoing a hysterectomy for a benign indication. When VH is technically not feasible, a LH or AH is performed. LH resulted in more rapid recovery, fewer febrile episodes and less wound complications compared to AH. The RH is not superior compared to the LH and is associated with higher costs.
Since the introduction of laparoscopy, the VH and AH decreased and the rate of LH significantly increased between 2002 and 2012. Performing a LH gives the opportunity to inspect the abdominal cavity and to easily perform an opportunistic salpingectomy compared to VH. An opportunistic salpingectomy during a hysterectomy for benign indication might reduce the overall risk of ovarian cancer.
Additionally, patients experience less postoperative pain after a LH compared to a VH and therefore need less post-operative pain medication. Advantages of the VH compared to the LH are a shorter operation duration, no visible scars and a lower chance of dehiscence of the vaginal cuff.
In 2004, a novel approach of endoscopic surgery was described, 'Natural Orifice Transluminal Endoscopic Surgery (NOTES) by researchers at the John Hopkins University. It is a surgical technique using natural orifices of the body (e.g. mouth, anus, urethra, vagina) to perform scarless surgery. The vaginal approach is called the vNOTES technique. NOTES is an emerging field within minimal access surgery, evolves and presents multiple possibilities for innovation and development. The initial approach was trans gastric, but subsequently, NOTES has been evolved, resulting in trans rectal, trans gastric, transvaginal, and transurethral approaches nowadays.
In 2012, the first vNOTES hysterectomy, also called vaginal assisted NOTES hysterectomy (VANH) was performed. vNOTES surgery can be used for different indications, for example hysterectomy, adnexectomy or salpingectomy in case of an ectopic pregnancy.
In 2018, the first randomised controlled trial (RCT) comparing TLH with VANH in 70 women was published. This HALON trial showed VANH was non-inferior to TLH. Compared to TLH, surgery time was significantly shorter, patients experience less post-operative pain and same day discharge (SDD) was possible in 77% of the women who underwent the VANH compared to 43% after TLH. Besides, the VANH showed less post-operative complications.
Except for the HALON trial and two retrospective studies and case-control studies, there is little literature about VANH.
No studies have been performed comparing the VH with the VANH. Because the VH is the preferred method to perform a hysterectomy for a benign indication, there is a need to compare VH with VANH and to explore the indications to perform a VANH.
The aim of this study is to compare the VANH with the VH for same day discharge (SDD), complications, treatment related outcomes, post-operative recovery, quality of life and cost-effectiveness.
We hypothesize that patients who underwent a VANH procedure are more often able to be treated in SDD setting.
Study Type
Enrollment (Anticipated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ilse Bekkers
- Phone Number: 0031640970334
- Email: il.bekkers@zuyderland.nl
Study Contact Backup
- Name: Martine Wassen
- Email: m.wassen@zuyderland.nl
Study Locations
-
-
Noord Brabant
-
Eindhoven, Noord Brabant, Netherlands
- Not yet recruiting
- Catharina Medical Centre
-
Contact:
- Huib Van Vliet, Dr
- Phone Number: 0031402399111
- Email: huib.v.vliet@catharinaziekenhuis.nl
-
-
Noord-Brabant
-
Heerlen, Noord-Brabant, Netherlands, 5644AD
- Recruiting
- Zuyderland Medical Centre
-
Contact:
- Martine Wassen
- Email: m.wassen@zuyderland.nl
-
Contact:
- Ilse Bekkers
- Phone Number: 0640970334
- Email: il.bekkers@zuyderland.nl
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Written and orally given informed consent
- 18 years and older
- Native Dutch speaker or in control of the Dutch language in speaking and writing
- Indication for hysterectomy for benign indication
- Possible to perform a VH judged by experienced (resident) gynaecologist during gynaecological examination
Exclusion Criteria:
- Any contra-indication for VH (for example, large uterus myomatosus, not enough descensus, etc) as judged by experienced gynaecologist
- History of more than 1 caesarean section
- History of endometriosis
- History of rectal surgery
- History of pelvic radiation
- Suspected rectovaginal endometriosis
- History of pelvic inflammatory disease, especially prior tubo-ovarian or pouch of Douglas abscess or suspected adhesions due to (ruptured) inflammatory disease (for example ruptured appendicitis)
- Virginity
- Pregnancy
- Indication for anterior or posterior colporrhaphy during the same surgery
- Indication of mid urethral slings
- Uterus myomatosus will not be an exclusion criteria but the surgeon will indicate if it is possible to remove the uterus vaginally.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: VANH hysterectomy
Access to the peritoneal cavity will be performed similar to vaginal surgery by a circular incision around the cervix, anterior and posterior colpotomy and transsecting the sacro-uterine ligaments.
The vNOTES port will be placed to get access to the abdominal cavity and a pneumoperitoneum will be created.
After positioning in 20o degree Trendelenburg laparoscopic instruments will be introduced.
The peritoneal cavity and ureters are inspected.
The hysterectomy is performed by dissecting from caudally to cranially.
The fallopian tubes will be removed elective after counselling in the outpatient clinic and the ovaries will be removed on indication only.
Haemostasis is checked and the vNOTES port and the uterus are removed trans-vaginally and the pneumoperitoneum is deflated.
The vaginal cuff will be closed using a running Vicryl-1 suture.
The urinary bladder catheter will be removed directly postoperative.
|
Vaginal assited NOTES hysterectomy
|
Active Comparator: Vaginal hysterectomy
A circumferential incision is made around the cervix.
Access to the peritoneal cavity will be performed through anterior and posterior colpotomy.
The sacro-uterine ligaments, ligamenta cardinalia uterine arteries will be clamped and dissected.
Finally, the ovarian ligament, round ligament and fallopian tubes will be dissected and tied.
The uterus will be removed and the vagina will be closed.
The urinary bladder catheter will be removed directly postoperative.
|
Vaginal hysterectomy
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Percentage of same day discharge
Time Frame: First 24hours after surgery
|
Same day discharge
|
First 24hours after surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Complications
Time Frame: Week 6 after surgery
|
Severity scored by Clavien Dindo classifications
|
Week 6 after surgery
|
Treatment related outcomes-1
Time Frame: During surgery
|
Conversion
|
During surgery
|
Intended number of salphingectomies in each group
Time Frame: During surgery
|
Intended number of salphingectomies
|
During surgery
|
Performed number of salphingectomies in each group
Time Frame: During surgery
|
Performed number of salphingectomies
|
During surgery
|
Recovery Index-10 (RI-10) pre- and postoperative
Time Frame: Week 12 after surgery
|
Recovery Index-10 (RI-10)
|
Week 12 after surgery
|
Health- related Quality of LIfe (EQ-5D-5L questionnaire)
Time Frame: Week 12 after surgery
|
EQ-5D-5L questionnaire
|
Week 12 after surgery
|
Costs
Time Frame: Week 12 after sugery
|
Intervention costs, hospital costs, health care costs outside the hospital (using iMCQ questionnaire)
|
Week 12 after sugery
|
Cost effectiveness
Time Frame: Week 12 after surgery
|
Cost effectiveness between vaginal NOTES hysterectomy versus vaginal hysterectomy comparing the costs as mentioned at outcome 8
|
Week 12 after surgery
|
Treatment related outcomes-2
Time Frame: During surgery
|
Time in operating theatre in minutes
|
During surgery
|
Treatment related outcomes- 3
Time Frame: During surgery
|
Surgery time in minutes
|
During surgery
|
Treatment related outcomes -4
Time Frame: During surgery
|
blood loss in mL
|
During surgery
|
Treatment related outcomes -5
Time Frame: First 24 hours after surgery
|
Pain after surgery measured on numeric rating scale
|
First 24 hours after surgery
|
Treatment related outcomes -6
Time Frame: Day 7 after surgery
|
Recovery of pain in first 7 days after surgery measured on numeric rating scale
|
Day 7 after surgery
|
Treatment related outcomes - 7
Time Frame: Day 7 after surgery
|
Use of analgesics
|
Day 7 after surgery
|
Treatment related outcomes - 8
Time Frame: Week 6 after surgery
|
resumption of daily activity
|
Week 6 after surgery
|
Treatment related outcomes - 9
Time Frame: Week 6 after surgery
|
hospital re-admission
|
Week 6 after surgery
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Martine Wassen, Zuyderland Medical Centre
Publications and helpful links
General Publications
- Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, Bonsel G, Badia X. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011 Dec;20(10):1727-36. doi: 10.1007/s11136-011-9903-x. Epub 2011 Apr 9.
- EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199-208. doi: 10.1016/0168-8510(90)90421-9.
- M Versteegh M, M Vermeulen K, M A A Evers S, de Wit GA, Prenger R, A Stolk E. Dutch Tariff for the Five-Level Version of EQ-5D. Value Health. 2016 Jun;19(4):343-52. doi: 10.1016/j.jval.2016.01.003. Epub 2016 Mar 30.
- Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004 Jul;60(1):114-7. doi: 10.1016/s0016-5107(04)01309-4.
- Baekelandt J, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BW, Bosteels JJ. Authors' reply re: Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a daycare procedure: a randomised controlled trial. BJOG. 2019 Jul;126(8):1078-1079. doi: 10.1111/1471-0528.15744. Epub 2019 Apr 24. No abstract available.
- Baekelandt J, Kapurubandara S. Benign Gynaecological procedures by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): Complication data from a series of 1000 patients. Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:221-224. doi: 10.1016/j.ejogrb.2020.10.059. Epub 2020 Oct 28.
- Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Sogaard M. Global epidemiology of hysterectomy: possible impact on gynecological cancer rates. Am J Obstet Gynecol. 2015 Jul;213(1):23-29. doi: 10.1016/j.ajog.2015.02.019. Epub 2015 Feb 25.
- Committee Opinion No. 701 Summary: Choosing The Route Of Hysterectomy For Benign Disease. Obstet Gynecol. 2017 Jun;129(6):1149-1150. doi: 10.1097/AOG.0000000000002108.
- Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015 Aug 12;2015(8):CD003677. doi: 10.1002/14651858.CD003677.pub5.
- Neis KJ, Zubke W, Romer T, Schwerdtfeger K, Schollmeyer T, Rimbach S, Holthaus B, Solomayer E, Bojahr B, Neis F, Reisenauer C, Gabriel B, Dieterich H, Runnenbaum IB, Kleine W, Strauss A, Menton M, Mylonas I, David M, Horn LC, Schmidt D, Gass P, Teichmann AT, Brandner P, Stummvoll W, Kuhn A, Muller M, Fehr M, Tamussino K. Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015). Geburtshilfe Frauenheilkd. 2016 Apr;76(4):350-364. doi: 10.1055/s-0042-104288.
- Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ. 2005 Jun 25;330(7506):1478. doi: 10.1136/bmj.330.7506.1478.
- Driessen SR, Baden NL, van Zwet EW, Twijnstra AR, Jansen FW. Trends in the implementation of advanced minimally invasive gynecologic surgical procedures in the Netherlands. J Minim Invasive Gynecol. 2015 May-Jun;22(4):642-7. doi: 10.1016/j.jmig.2015.01.026. Epub 2015 Feb 3.
- van Lieshout LAM, Steenbeek MP, De Hullu JA, Vos MC, Houterman S, Wilkinson J, Piek JM. Hysterectomy with opportunistic salpingectomy versus hysterectomy alone. Cochrane Database Syst Rev. 2019 Aug 28;8(8):CD012858. doi: 10.1002/14651858.CD012858.pub2.
- Santos BF, Hungness ES. Natural orifice translumenal endoscopic surgery: progress in humans since white paper. World J Gastroenterol. 2011 Apr 7;17(13):1655-65. doi: 10.3748/wjg.v17.i13.1655.
- Rolanda C, Lima E, Pego JM, Henriques-Coelho T, Silva D, Moreira I, Macedo G, Carvalho JL, Correia-Pinto J. Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc. 2007 Jan;65(1):111-7. doi: 10.1016/j.gie.2006.07.050.
- Nieuwenhuis D, Velthuis S, Bonjer J, Sietses C. [Transanal total mesorectal excision: a new treatment option for rectal cancer]. Ned Tijdschr Geneeskd. 2014;158(6):A7054. Dutch.
- Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, Moran B, Hanna GB, Mortensen NJ, Tekkis PP; TaTME Registry Collaborative. Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases. Ann Surg. 2017 Jul;266(1):111-117. doi: 10.1097/SLA.0000000000001948.
- Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012 Jun;51(2):217-21. doi: 10.1016/j.tjog.2012.04.009.
- Wang CJ, Huang HY, Huang CY, Su H. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery for nonprolapsed uteri. Surg Endosc. 2015 Jan;29(1):100-7. doi: 10.1007/s00464-014-3639-y. Epub 2014 Oct 1.
- Yang YS, Kim SY, Hur MH, Oh KY. Natural orifice transluminal endoscopic surgery-assisted versus single-port laparoscopic-assisted vaginal hysterectomy: a case-matched study. J Minim Invasive Gynecol. 2014 Jul-Aug;21(4):624-31. doi: 10.1016/j.jmig.2014.01.005. Epub 2014 Jan 21.
- Lee CL, Wu KY, Su H, Wu PJ, Han CM, Yen CF. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (NOTES): a series of 137 patients. J Minim Invasive Gynecol. 2014 Sep-Oct;21(5):818-24. doi: 10.1016/j.jmig.2014.03.011. Epub 2014 Mar 25.
- Hanstede MM, Burger MJ, Timmermans A, Burger MP. Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands. Acta Obstet Gynecol Scand. 2012 Feb;91(2):220-5. doi: 10.1111/j.1600-0412.2011.01309.x.
- David-Montefiore E, Rouzier R, Chapron C, Darai E; Collegiale d'Obstetrique et Gynecologie de Paris-Ile de France. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod. 2007 Jan;22(1):260-5. doi: 10.1093/humrep/del336. Epub 2006 Sep 1.
- Kruger PF, Mehta C, Lee P. Predictors of Length of Stay After Vaginal Hysterectomy. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S246. doi: 10.1016/j.jmig.2015.08.860. Epub 2015 Oct 15. No abstract available.
- Allam IS, Makled AK, Gomaa IA, El Bishry GM, Bayoumy HA, Ali DF. Total laparoscopic hysterectomy, vaginal hysterectomy and total abdominal hysterectomy using electrosurgical bipolar vessel sealing technique: a randomized controlled trial. Arch Gynecol Obstet. 2015 Jun;291(6):1341-5. doi: 10.1007/s00404-014-3571-3. Epub 2014 Dec 19.
- Morton M, Cheung VYT, Rosenthal DM. Total laparoscopic versus vaginal hysterectomy: a retrospective comparison. J Obstet Gynaecol Can. 2008 Nov;30(11):1039-1044. doi: 10.1016/S1701-2163(16)32999-1.
- Sesti F, Cosi V, Calonzi F, Ruggeri V, Pietropolli A, Di Francesco L, Piccione E. Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri. Arch Gynecol Obstet. 2014 Sep;290(3):485-91. doi: 10.1007/s00404-014-3228-2. Epub 2014 Apr 8.
- Liu L, Yi J, Cornella J, Butterfield R, Buras M, Wasson M. Same-Day Discharge after Vaginal Hysterectomy with Pelvic Floor Reconstruction: Pilot Study. J Minim Invasive Gynecol. 2020 Feb;27(2):498-503.e1. doi: 10.1016/j.jmig.2019.04.010. Epub 2019 Apr 10.
- Wang CJ, Go J, Huang HY, Wu KY, Huang YT, Liu YC, Weng CH. Learning curve analysis of transvaginal natural orifice transluminal endoscopic hysterectomy. BMC Surg. 2019 Jul 10;19(1):88. doi: 10.1186/s12893-019-0554-0.
- Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996 Jul;175(1):10-7. doi: 10.1016/s0002-9378(96)70243-0.
- Jakobsen JC, Gluud C, Wetterslev J, Winkel P. When and how should multiple imputation be used for handling missing data in randomised clinical trials - a practical guide with flowcharts. BMC Med Res Methodol. 2017 Dec 6;17(1):162. doi: 10.1186/s12874-017-0442-1.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- NL76240.096.21
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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