Background: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is gaining increasing popularity among gynaecological surgeons worldwide due to its minimally invasive nature and associated benefits. However, despite its growing adoption, it remains a relatively novel surgical technique that continues to be evaluated and refined in clinical practice. The primary objective of this study is to share and analyse our initial experiences with the implementation of vNOTES hysterectomy across six specialised gynaecological centres in Turkey.
Methods: This retrospective analysis included all women who underwent vNOTES hysterectomy, with or without salpingo-oophorectomy, for benign or malignant conditions. All procedures adhered to the standardised protocol described by Baekelandt et al. Data on baseline patient characteristics, intraoperative details, and postoperative outcomes were collected and analysed.
Results: A total of 685 patients underwent vNOTES procedures. Among them, 64 women (9.3%) had a history of one caesarean delivery, 38 (5.5%) had two prior caesareans, and 11 (1.6%) had three or more. Myoma, with or without accompanying metrorrhagia, was the most common surgical indication (53.0%). The mean operative time was 72.4 ± 40.2 min, and the average haemoglobin decrease was 1.3 ± 1.0 g/dL. The mean uterine weight was 204 ± 145 g. Intraoperative complications occurred in 1.7% of cases (n = 12), while postoperative complications were observed in 1.4% (n = 10). Conversion to conventional laparoscopy occurred in six cases (0.9%), primarily due to an obliterated pouch of Douglas or intraoperative complications. The average hospital stay was 2.3 ± 1.4 days.
Conclusions: These findings support vNOTES as a safe and effective surgical approach, offering a viable alternative to traditional laparoscopic or vaginal techniques in select patient populations.
Keywords: Natural orifice transluminal endoscopic surgery; hysterectomy; minimally invasive surgery.
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) combines traditional vaginal surgical techniques with advanced single-port laparoscopy to treat various gynaecological conditions. Compared to conventional multiport laparoscopic surgery, vNOTES offers several key advantages, including reduced postoperative pain, faster recovery, shorter operative times, and improved cosmetic outcomes due to the absence of abdominal incisions. In a retrospective study conducted across six gynaecological centres, we evaluated the clinical outcomes of 685 hysterectomy procedures performed using vNOTES. We assessed operative time, postoperative pain scores, hospital stay duration, and complication rates. This multicentre study provides robust evidence supporting the efficacy and safety of vNOTES for hysterectomies performed for a wide range of uterine pathologies.