European journal of obstetrics, gynecology, and reproductive biology · 2026
vNOTES vs laparoscopic hysterectomy following conization with positive surgical margins: Surgical outcomes and postoperative HPV results.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hanedan Candost, Nur Inal Ayse, Köksal Oğuz Kaan, Baydemir Şahin Kaan, Öztürk Neslihan, Nur Öncü Hande, Ege Gökçen, Ege Volkan, Şahin Duran Firdevs, Yeşim Tezcan Aysu, Zengin Aksel Tuba, Korkmaz Vakkas, Kayıkcıoğlu Fulya
Аннотация
OBJECTIVE: To compare perioperative outcomes, pathological findings, and postoperative human papillomavirus (HPV) clearance between vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy and laparoscopic hysterectomy following cervical conization with positive surgical margins.
STUDY DESIGN: This retrospective comparative cohort study included 105 patients who underwent hysterectomy following cervical conization with positive surgical margins at a single gynaecologic oncology centre between January 2023 and March 2026. Patients were treated with either laparoscopic hysterectomy (n = 70) or vNOTES hysterectomy (n = 35). Perioperative outcomes, complications, residual disease rate, surgical margin status, and postoperative HPV status were compared between groups.
RESULTS: The vNOTES group demonstrated a significantly shorter operative time (45.0 vs 60.0 min; p < 0.001), a shorter length of hospital stay (1.0 vs 2.0 days; p < 0.001), and a significantly lower rate of drain placement (0.0% vs 25.7%; p < 0.001) compared with the laparoscopic group. No significant differences were observed in intraoperative or postoperative complication rates, conversion, readmission or reoperation between groups (all p > 0.05). The residual disease rate was comparable between the laparoscopic and vNOTES groups (37.1% vs 34.3%; p = 0.832), as were the negative surgical margin rate (95.7% vs 91.4%; p = 0.398) and the postoperative HPV clearance rate (75.4% vs 78.1%; p = 1.000).
CONCLUSIONS: vNOTES hysterectomy is a safe and effective minimally invasive alternative to laparoscopic hysterectomy following cervical conization with positive surgical margins, offering improved perioperative outcomes while achieving comparable short-term pathological and HPV outcomes. These findings suggest that vNOTES may be considered a feasible minimally invasive alternative in this clinically challenging setting. Further prospective multicentre studies are needed to validate these findings.
STUDY DESIGN: This retrospective comparative cohort study included 105 patients who underwent hysterectomy following cervical conization with positive surgical margins at a single gynaecologic oncology centre between January 2023 and March 2026. Patients were treated with either laparoscopic hysterectomy (n = 70) or vNOTES hysterectomy (n = 35). Perioperative outcomes, complications, residual disease rate, surgical margin status, and postoperative HPV status were compared between groups.
RESULTS: The vNOTES group demonstrated a significantly shorter operative time (45.0 vs 60.0 min; p < 0.001), a shorter length of hospital stay (1.0 vs 2.0 days; p < 0.001), and a significantly lower rate of drain placement (0.0% vs 25.7%; p < 0.001) compared with the laparoscopic group. No significant differences were observed in intraoperative or postoperative complication rates, conversion, readmission or reoperation between groups (all p > 0.05). The residual disease rate was comparable between the laparoscopic and vNOTES groups (37.1% vs 34.3%; p = 0.832), as were the negative surgical margin rate (95.7% vs 91.4%; p = 0.398) and the postoperative HPV clearance rate (75.4% vs 78.1%; p = 1.000).
CONCLUSIONS: vNOTES hysterectomy is a safe and effective minimally invasive alternative to laparoscopic hysterectomy following cervical conization with positive surgical margins, offering improved perioperative outcomes while achieving comparable short-term pathological and HPV outcomes. These findings suggest that vNOTES may be considered a feasible minimally invasive alternative in this clinically challenging setting. Further prospective multicentre studies are needed to validate these findings.