- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05884658
Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery Versus or Laparoscopic Hysterectomy (vNOTESHC)
vNOTEsHC: Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery Versus or Laparoscopic Hysterectomy: a Randomized Controlled Trial
In France, there are approximately 62,000 hysterectomies per year, 70% of which are benign. It is the most frequent surgical procedure in gynecology.
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.
Study Overview
Status
Conditions
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Florence RANCON
- Phone Number: +33 0477829458
- Email: florence.rancon@chu-st-etienne.fr
Study Contact Backup
- Name: Céline CHAULEUR, PhD
- Phone Number: +33 0477828383
- Email: celine.chauleur@chu-st-etienne.fr
Study Locations
-
-
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Bron, France, 69677
- HFME - Hospices Civils de Lyon
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Principal Investigator:
- Géry LAMBLIN
-
Contact:
- Géry LAMBLIN
- Email: gery.lamlin@chu-lyon.fr
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Clermont-Ferrand, France, 63003
- CHU Clermont-Ferrand
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Sub-Investigator:
- Sandra CURINIER, PH
-
Contact:
- Sandrine CAMPAGNE-LOISEAU, PH
- Email: scampagne-loiseau@chu-clermontferrand.fr
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Principal Investigator:
- Sandrine CAMPAGNE-LOISEAU, PH
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Issoire, France, 63500
- Ch Issoire
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Contact:
- Aslam MANSOOR
- Email: amansoor@ch-issoire.fr
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Principal Investigator:
- Aslam MANSOOR, PH
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Saint-Étienne, France, 42055
- CHU Saint-Etienne
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Contact:
- Céline CHAULEUR, PhD
- Phone Number: 0477828383
- Email: celine.chauleur@chu-st-etienne.fr
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Principal Investigator:
- Thomas CORSINI
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Sub-Investigator:
- Céline CHAULEUR
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Sub-Investigator:
- Ahamd MEDHI
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Saint-Étienne, France, 42100
- Clinique Mutualiste de Saint-Etienne
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Contact:
- Quentin REBOUL, MD
- Email: quentinreboul@free.fr
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Principal Investigator:
- Quentin REBOUL, MD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Any woman received in preoperative consultation in the Gynecology-Obstetrics Department for a benign pathology of a uterus estimated to be large requiring a hysterectomy.
- 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:
- Woman refusing to participate in the study (lack of consent)
- 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
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 |
---|---|
Active Comparator: laparoscopic hysterectomy
Laparoscopic Hysterectomy will be performed in a standardized manner
|
laparoscopic hysterectomy uses a standardized procedure
|
Experimental: natural vaginal orifice transluminal endoscopic system for hysterectomies (vNOTES)
Vaginal hysterectomy will be performed in a standardized manner using transluminal endoscopic system
|
hysterectomy via the vaginal approach by vNOTES (natural vaginal orifice transluminal endoscopic system for hysterectomies)
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion of patient with complications
Time Frame: From surgery to 6 weeks of surgery
|
The proportion of patients with at least one pre- and post-operative complication at 6 weeks will be estimated along with its 95% confidence interval in each surgical strategy group. The primary endpoint is a composite endpoint including the occurrence of intraoperative and postoperative complications within 6 weeks of surgery. Postoperative complications were Infectious complications, Bleeding complications and All hospital readmissions related to the procedure Postoperative complications will be classified according to the Clavien-Dindo classification Intraoperative complications will be defined as :
|
From surgery to 6 weeks of surgery
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Conversion
Time Frame: During surgery
|
Number of patients with conversion during surgery
|
During surgery
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Post-operative pain
Time Frame: From surgery to 3 hours of surgery
|
Maximal Pain measured by a numerical scale : 0 no pain / 10 maximum pain
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From surgery to 3 hours of surgery
|
Short-term postoperative pain
Time Frame: From surgery to 1 week after surgery
|
Maximal short-term postoperative pain the first week after surgery measured by a numerical scale (0 no pain / 10 maximum pain) by a daily telephone call
|
From surgery to 1 week after surgery
|
Duration of postoperative reflex ileus
Time Frame: Day 0
|
Duration of post-operative reflex ileus between the day of the operation and the resumption of a transit (appearance of the first gas) in hours
|
Day 0
|
Duration of the operation
Time Frame: Surgery
|
operative time will be evaluated between the incision and the end of the closure, in minutes.
|
Surgery
|
Duration of hospitalization and the possibility of returning home
Time Frame: last day of hospitalization
|
The length of hospital stay will be assessed in days and the possibility of return home by the time in hours from surgical incision to a Chung≥ score of 9/10.
The Chung score assesses the possibility of a return home in ambulatory surgery.
|
last day of hospitalization
|
Sexual dysfunction
Time Frame: 3 months
|
Sexual disorders: sexual life will be assessed by the difference in the specific validated score (self-questionnaire) (PISQ12 with a score ranging from 0 to 48) between the inclusion date and 3 months after surgery for sexually active women.
|
3 months
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Céline CHAULEUR, PhD, CHU Saint-Etienne
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- 21PH265
- 2023-A01013-42 (Other Identifier: ANSM)
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
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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