vNOTES (vaginal natural orifice transluminal surgery) gynecological procedures in morbidly obese patients BMI≥40kg/m2: An experience in a Southeast Asian tertiary centre.

INTRODUCTION

Vaginal natural orifice transluminal surgery (vNOTES) is a promising tool in gynecology and is being increasingly adopted in minimally invasive surgery. The aim of this study is to assess the feasibility and outcomes of vNOTES for morbidly obese patients for gynecological surgeries.

MATERIAL AND

METHODS

Morbidly obese patients (BMI≥40kg/m2) who underwent vNOTES for gynecological conditions from March 2021 to June 2025 were identified. Data on patient demographics, operative factors, complications and postoperative outcomes were collected and analyzed. A literature review on gynecology vNOTES in morbidly obese patients was also performed.

RESULTS

32 patients were identified. The median BMI was 42.1kg/m2 (range 40.0 - 72kg/m2). Their age ranged from 23 to 77 years old. 50% of them had a previous abdominal or pelvic surgery. 50% were nulliparous. The most common procedure performed was total hysterectomy bilateral salpingoophorectomy (81.3%). One patient underwent pelvic lymph node dissection. The median operative time was 150mins (range 75 - 475mins). The median blood loss was 200mL (range 0 - 1700mL). The median length of stay was 2 days (range 1 - 38 days) and postoperative pain scores were low. One patient developed a postoperative pelvic collection that was treated conservatively. In the literature review comparing 3 other studies, the perioperative and postoperative complication rates and median operation time were generally comparable, although this interpretation is limited by the small sample sizes.

CONCLUSION

vNOTES is a feasible approach in morbidly obese patients for various gynaecological surgeries, demonstrating favourable outcomes.