Comparative Study of the Flipping Technique and Conventional Vaginal Natural Orifice Transluminal Endoscopic Surgery...

The aim of the study was to evaluate the clinical application value of the flipping technique in vaginal natural orifice transluminal endoscopic surgery (vNOTES) for myomectomy in cases involving numerous, large, and difficult-to-expose uterine fibroids, particularly those located at the fundus.

A retrospective analysis was conducted on the clinical data of 42 patients without fertility requirements but desiring uterine preservation who underwent flipping technique vNOTES myomectomy (case group) and 46 patients who underwent conventional vNOTES myomectomy (control group) at two hospitals between January 2024 and May 2025. Preoperative, intraoperative, and postoperative clinical data were compared between the two groups.

All surgeries were successfully completed in both groups. Compared with the control group, the flipping technique group had greater uterine volumes, a greater number of fibroids removed intraoperatively, and the ability to remove fibroids at higher positions (e.g., fundus). However, the flipping technique group also experienced longer operative times, greater intraoperative blood loss, and a longer durations before postoperative urinary catheter removal. These differences were statistically significant (p < 0.05).

The flipping technique in vNOTES offers advantages similar to conventional vNOTES, such as the absence of abdominal scarring and lower postoperative pain levels. Additionally, it offers the advantages of removing a greater number of fibroids and various types of fibroids, particularly those located at challenging positions such as the uterine fundus. This technique expands the indications for vNOTES myomectomy.