Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) Hysterectomy in Overweight and Obese Patients:...

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel surgical approach that confers on surgeons the dual advantages of vaginal and laparoscopic surgeries. There is a lack of literature comparing the vNOTES hysterectomy in obese and nonobese patients, especially in the Asian population. We aim to compare the surgical outcomes of vNOTES in patients with body mass index (BMI) <25 kg/m² and ≥25 kg/m².

This study involved a retrospective comparative study of 159 overweight and nonoverweight women who underwent vNOTES hysterectomy in a single tertiary care center between April 2021 and January 2024. Patients were stratified based on their BMI (<25 kg/m² or ≥25 kg/m²). Demographics, preoperative findings, intraoperative findings, and postoperative outcomes between the two groups were then compared.

Ninety-four women had normal BMI and 65 were overweight. No conversion to laparoscopic surgery or open surgery was needed. The mean age and parity were 52.3 (±10.1) and 1.9 (±1.1), respectively. Operative time was significantly shorter in the nonoverweight group compared to the overweight group (99.1 ± 37.8 min vs. 115.2 ± 46.8 min, P < 0.01). There was significantly higher estimated blood loss (189.2 ± 207.5 mL vs. 129.6 ± 146.5 mL, P = 0.02) and longer hospitalization stay (1.75 ± 0.90 days vs. 1.46 ± 0.60 days, P < 0.01) for overweight patients compared to nonoverweight patients. There was no significant difference in pain scores using a numeric rating scale (P = 0.27).

This study contributes valuable insights into the outcomes of vNOTES in Asian patients and demonstrates that vNOTES is a safe and effective surgical technique for overweight or obese patients. Overweight or obese patients scheduled for vNOTES procedures must be informed about the increased risk of blood loss and expected longer postoperative hospitalization as compared to nonobese patients.