Arch Gynecol Obstet. 2026 Apr 9;313(1):159. doi: 10.1007/s00404-026-08414-2.
ABSTRACT
PURPOSE: Studies on vaginal natural orifice transluminal endoscopic surgery (vNOTES), which provides enhanced endoscopic vision via the vaginal route, are limited. Therefore, this study aimed to evaluate the feasibility, safety, and perioperative outcomes of vNOTES hysterectomy in symptomatic patients with giant polymyomatous uteri and no prior vaginal delivery.
METHODS: A prospective single-centre case series was conducted between July 2023 and July 2025. Patients with symptomatic uterine myomatosis and a uterine size equivalent to a gestational age of ≥ 20 weeks with no prior vaginal deliveries were included. The operation time, preoperative and postoperative haemoglobin levels, uterine weight, complications, and length of hospital stay were analysed.
RESULTS: Forty patients met the inclusion criteria. The mean operative time was 95 ± 28 min. The mean preoperative haemoglobin concentration was 11.8 ± 1.2 g/dL, whereas it was 10.9 ± 1.1 g/dL postoperatively. The mean uterine weight was 1,012 ± 312 g. The complication rate was 8%. The major complication rate was 4%. No procedures were converted to laparotomy. The median hospitalisation duration was 23.1 h.
CONCLUSION: vNOTES hysterectomy appears to be a feasible minimally invasive approach for giant polymyomatous uteri in patients with no prior vaginal deliveries, with favourable perioperative outcomes in this prospective case series.
PMID:41954781 | DOI:10.1007/s00404-026-08414-2
