Evaluating the Safety and Recovery Benefits of vNOTES Compared to Laparoscopy in Obese Patients

This study aims to compare perioperative outcomes and recovery parameters between vaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH) in obese patients undergoing hysterectomy for benign indications.

A retrospective cohort study was conducted including 112 patients with a body mass index (BMI) ≥ 30 kg/m² who underwent hysterectomy between June 2022 and May 2025. Fifty-three patients underwent vNOTES and 59 underwent TLH. Demographic data, intraoperative parameters, postoperative recovery metrics, pain scores, and complications were recorded and statistically compared.

No significant differences were found between groups in terms of BMI, uterine volume, or operative time. However, the vNOTES group exhibited significantly lower estimated blood loss (127.73 ± 88.93 mL vs. 300 ± 120 mL; p < 0.0001), shorter time to ambulation (5.86 ± 1.09 h vs. 6.47 ± 1.20 h; p = 0.006), shorter hospital stay (1.47 ± 0.54 days vs. 1.86 ± 0.43 days; p < 0.0001), and quicker return to daily activities (6.56 ± 1.15 vs. 8.01 ± 1.10 days; p < 0.0001). Postoperative pain scores were significantly lower in the vNOTES group at all measured time points. Complication rates were low in both groups, with no statistically significant difference.

vNOTES appears to be a safe and effective alternative to laparoscopy in obese patients, offering superior outcomes in terms of recovery time, pain, and blood loss. These findings support the broader adoption of vNOTES in high-risk populations, though further prospective studies are warranted.