Clinical outcomes of vNOTES, vaginal, and laparoscopic hysterectomy: insights from a single-center study

This study aimed to compare the clinical outcomes, feasibility, and safety of three minimally invasive hysterectomy techniques-vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and transvaginal natural orifice transluminal endoscopic surgery (vNOTES)-in patients with benign uterine pathologies.

This single-center, pragmatic retrospective cross-sectional study was conducted at a tertiary care center in İzmir, Türkiye, between January 2024 and April 2025. A total of 1,146 patients who underwent hysterectomy for benign gynecological indications were included: 298 VH, 730 LH, and 118 vNOTES. Patients with advanced pelvic organ prolapse, severe intra-abdominal adhesions, or incomplete records were excluded. Evaluated outcomes included operative time, estimated blood loss, uterine weight, postoperative pain (visual analogue scale at 12 and 24 hours), complication rates (Clavien-Dindo classification), and length of hospital stay.

VH had the shortest operative time, while vNOTES was faster than LH. Uterine weight was significantly higher in the LH and vNOTES groups. Postoperative pain at 12 hours was lowest in the vNOTES group, with no significant difference at 24 hours. The vNOTES group demonstrated the lowest overall complication rate (2.5%), and vaginal cuff complications were observed only in the VH and LH groups.

vNOTES hysterectomy was associated with lower early postoperative pain and fewer complications, supporting its safety and effectiveness in appropriately selected patients. Prospective multicenter studies are warranted to confirm these findings.