Related Experiment Video
Updated: Jul 13, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Feasibility and short-term outcomes of vNOTES versus conventional laparoscopic hysterectomy in obese patients
Varol Gülseren1, Bilgesu Çetinel Kaygun2, Kemal Güngördük3
1Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey.
Background And Objective:
We compared the short-term outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) versus conventional laparoscopic surgery (CLS) hysterectomy in women with body mass index (BMI) ≥ 30 kg/m², with explicit acknowledgement of the temporal and confounding limitations inherent to our non-randomised retrospective design.
Methods:
This multicentre retrospective cohort study reviewed records of obese women who underwent hysterectomy at two tertiary university hospitals in Turkey between 2020 and 2024. CLS predominated during 2020-2021 and vNOTES from 2022 onwards, reflecting evolving institutional experience rather than formal allocation. The principal comparative endpoint was umbilical-region VAS at 24 h; feasibility (completion without conversion to laparotomy) is reported descriptively. A pre-specified hierarchical testing strategy was applied, and complications were graded by Clavien-Dindo classification.
Results:
Of 168 eligible women (CLS n = 126, vNOTES n = 42) from two centres, all procedures were completed minimally invasively with zero conversions to laparotomy in both arms. Umbilical pain at 24 h (VAS) was substantially lower with vNOTES (5.4 ± 1.2 vs. 2.1 ± 0.9; p < 0.001). Operative times were broadly comparable (mean difference 5.0 min; not significant under the hierarchical plan). Serious (Clavien-Dindo grade IIIb) complications were numerically more frequent in the vNOTES arm (4.8% vs. 0.8%); the study was not powered to interpret this difference, and no inference of safety equivalence should be drawn. OSAS/PSAS scar scores were applicable only to the CLS group and are reported descriptively.
Conclusions:
In this retrospective cohort of obese women undergoing hysterectomy, vNOTES was associated with substantially lower umbilical-region pain and comparable operative times relative to CLS. Given temporal confounding from sequential non-randomised allocation, these associations should not be interpreted causally, and the near-absence of Class III obesity limits generalisability to the population most likely to benefit. Adequately powered prospective randomised trials are required to confirm these preliminary findings.
