Transvaginal Natural orifice transluminal endoscopic hysterectomy vs. abdominal laparoscopic approach in real-life practices: a retrospective cohort study.

Abstract

Purpose: This study aims to retrospectively evaluate the surgical outcomes of total hysterectomy performed via Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) compared to laparoscopic hysterectomy (LAP) in treating benign gynecologic conditions in a real-world clinical setting.

Methods: This retrospective cohort study was conducted at Galilee Medical Center, Israel, between March 2021 and 2023. A total of 133 women were included in the study. The vNOTES group comprised 58 women, while 75 women underwent LAP. All women eligible for laparoscopic hysterectomy for benign conditions were offered the vNOTES approach. Exclusion criteria included prior pelvic radiation, active genital infections, rectovaginal endometriosis, or the need for oncogynecologic surgery related to malignancy.

Results: The vNOTES group demonstrated significantly shorter operative times (69.5 vs. 117.4 min, p < 0.001) and anesthesia durations (102 vs. 146.3 min, p < 0.001), as well as reduced blood loss (108.6 mL vs. 237.9 mL, p < 0.001) compared to the LAP group. Postoperative pain, assessed by VAS scores, was significantly lower in the vNOTES group than in the LAP group (2.33 vs. 3.11, p = 0.013), with fewer requests for intravenous analgesics. No significant differences were observed between the groups in complication rates, conversion to laparotomy, or postoperative hospital stays.

Conclusion: The vNOTES hysterectomy demonstrated shorter operative and anesthesia times, reduced blood loss, lower postoperative pain, and intravenous analgesic requirements compared to laparoscopic hysterectomy, without increasing complication rates. These findings suggest that vNOTES offers a viable, minimally invasive alternative to conventional laparoscopic hysterectomy for the treatment of benign gynecologic conditions. Further prospective studies are needed to assess long-term outcomes and the impact on quality of life.