Related Experiment Video
Updated: Sep 13, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
The Erkilinc Technique for vNOTES Hysterectomy: A Speculum-Assisted Approach Without Prior Vaginal Dissection: A
Selçuk Erkılınç1, Serhan Can İşcan2, Sena Özcan3
1Department of Obstetrics and Gynecology, Istanbul Aydın University, Istanbul, Türkiye.
Objective:
To describe a novel speculum-assisted glove-port technique for vNOTES hysterectomy (Erkilinc technique) and to evaluate its feasibility, safety, and learning curve in patients undergoing surgery for benign indications.
Design:
Retrospective Case Series.
Setting:
Tertiary referral center.
Participants:
A total of 163 consecutive women undergoing vNOTES hysterectomy for benign indications between January 2019 and November 2023.
Interventions:
vNOTES hysterectomy using a speculum-integrated glove-port system allowing complete laparoscopic execution without prior vaginal dissection.
Measurements And Main Results:
The mean surgical time was 70.6 ± 24.5 minutes. The mean uterine weight was 280.9 ± 214 g. The mean decrease in hemoglobin was 0.9 ± 1.4 g/dL. The overall complication rate was 3.1%, with no ureteric or bowel injuries observed. The mean VAS scores were 4.7 at 4 hours and 3.3 at 24 hours. Learning curve analysis demonstrated a significant reduction in surgical time over successive cases, with procedural proficiency achieved after approximately 45 cases based on CUSUM analysis. Surgical times were comparable to those reported for Alexis-based systems.
Conclusion:
The Erkilinc technique represents a reproducible and efficient vNOTES approach that avoids prior vaginal dissection and eliminates the need for internal wound retractors. This technique may expand the applicability of vNOTES to non-prolapsed uteri while maintaining safety and operative efficiency.
