Can vaginal natural orifice transluminal endoscopic surgery hysterectomy be performed in patients with an enlarged uterus?

AIM: In this study, the application of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy (CLS) underwent hysterectomy in patients with enlarged uterus was compared.

METHODS

This multicenter study enrolled patients with an enlarged uterus (≥300 g) who underwent minimally invasive hysterectomy using either CLS or vNOTES in the Department of Obstetrics and Gynecology between January 2020 and December 2024.

RESULTS

Among the enrolled patients with an enlarged uterus, 39 (65.0%) underwent conventional laparoscopy, and 21 (35.0%) underwent vNOTES. The median operative times were 80 (50-140) min in the conventional laparoscopy group and 70 (60-130) min in the vNOTES group (p = 0.008). Median blood loss was significantly lower in the vNOTES group (140 [80-210] vs. 160 [90-370] mL; p = 0.013). The length of hospital stay was comparable between groups. Intraoperative bladder injury occurred in one patient in each group-conventional laparoscopy (2.6%) and vNOTES (4.8%) (p = 0.651). Conversion to laparotomy was required in three patients (7.7%) in the CLS group and one patient (4.8%) in the vNOTES group (p = 0.664). The visual analog scale pain score was significantly lower in the vNOTES group at 6, 12, and 24 h postoperatively.

CONCLUSION

vNOTES was confirmed to be a safe, feasible, and effective approach for hysterectomy in patients with an enlarged uterus.