Can vaginal natural orifice transluminal endoscopic surgery hysterectomy be performed in patients with an enlarged uterus?

OpenAlex İngilizce

AIM: In this study, the application of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy (CLS) underwent hysterectomy in patients with enlarged uterus was compared. METHODS: This multicenter study enrolled patients with an enlarged uterus (≥300 g) who underwent minimally invasive hysterectomy using either CLS or vNOTES in the Department of Obstetrics and Gynecology between January 2020 and December 2024. RESULTS: Among the enrolled patients with an enlarged uterus, 39 (65.0%) underwent conventional laparoscopy, and 21 (35.0%) underwent vNOTES. The median operative times were 80 (50-140) min in the conventional laparoscopy group and 70 (60-130) min in the vNOTES group (p = 0.008). Median blood loss was significantly lower in the vNOTES group (140 [80-210] vs. 160 [90-370] mL; p = 0.013). The length of hospital stay was comparable between groups. Intraoperative bladder injury occurred in one patient in each group-conventional laparoscopy (2.6%) and vNOTES (4.8%) (p = 0.651). Conversion to laparotomy was required in three patients (7.7%) in the CLS group and one patient (4.8%) in the vNOTES group (p = 0.664). The visual analog scale pain score was significantly lower in the vNOTES group at 6, 12, and 24 h postoperatively. CONCLUSION: vNOTES was confirmed to be a safe, feasible, and effective approach for hysterectomy in patients with an enlarged uterus.