VANH vs Vaginal Hysterectomy: Which is Better for SDD?

VANH vs Vaginal Hysterectomy: Which is Better for SDD?

Modern gynaecological practice increasingly focuses on same-day discharge (SDD) to improve patient satisfaction and hospital efficiency. A recent randomised controlled trial published in BJOG investigated the outcomes of VANH vs Vaginal Hysterectomy for benign indications. The study specifically compared traditional vaginal hysterectomy (VH) with vaginal assisted natural orifice transluminal endoscopic surgery (VANH). Consequently, the results highlight significant differences in surgical efficiency and discharge potential.

Outcomes of VANH vs Vaginal Hysterectomy

The trial included 113 patients, with 42 undergoing VH and 71 undergoing VANH. Researchers discovered that same-day discharge occurred significantly more often in the VANH group. Specifically, 87.3% of VANH patients achieved SDD compared to only 71.4% of those in the VH group. This finding suggests that VANH offers a superior pathway for day-care surgical programs. Furthermore, the odds ratio of 2.76 reinforces the statistical strength of this clinical advantage.

Surgical Metrics and Recovery Comparison

In addition to discharge rates, the VANH technique demonstrated several operative benefits. For instance, the median operative time was 10 minutes shorter for VANH than for traditional vaginal hysterectomy. Additionally, intraoperative blood loss was significantly lower in the VANH group, with a median of 50 mL compared to 150 mL in the VH group. However, safety metrics remained comparable across both surgical approaches. Complication rates, pain scores, and overall analgesic use showed no significant differences between the two techniques during the first six weeks of recovery.

Implications for Gynaecological Surgeons

The study also noted that VANH allowed for more frequent elective opportunistic salpingectomies. This factor is increasingly important in modern surgery for ovarian cancer risk reduction. Although both methods are safe, VANH provides enhanced visualization and efficiency. Consequently, surgeons may find VANH to be the more versatile option for complex benign cases. Despite these surgical differences, the long-term quality of life and recovery index scores remained similar for all patients.

Frequently Asked Questions

Q1: Is same-day discharge more successful with VANH than with traditional vaginal hysterectomy?

Yes, the trial reported an 87.3% success rate for same-day discharge in the VANH group compared to 71.4% in the VH group.

Q2: Does the VANH technique take longer to perform?

No, the study actually found that VANH had a significantly shorter median operative time of 55 minutes, whereas vaginal hysterectomy took 65 minutes.

Q3: Are there more complications associated with the newer VANH method?

The researchers found no significant difference in complication rates between the two groups, indicating that both methods are equally safe for patients.

References

1. Bekkers IPW et al. Vaginal Hysterectomy Versus Vaginal Assisted Natural Orifice Transluminal Endoscopic Surgery Hysterectomy; Results of a Randomised Controlled Trial. BJOG. 2026 May 15. doi: 10.1111/1471-0528.70260. PMID: 42137913.
2. Baekelandt J et al. Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Versus Laparoscopic Hysterectomy. BJOG. 2019;126(3):339-346.