BMC Womens Health. 2026 Jul 20. doi: 10.1186/s12905-026-04698-3. Online ahead of print.
ABSTRACT
BACKGROUND AND OBJECTIVES: We compared the outcomes of complete pelvic lymph node dissection performed via multiport conventional laparoscopy (MCL) versus vaginal natural orifice transluminal endoscopic surgery (vNOTES) in patients with endometrial cancer in whom sentinel lymph node (SLN) mapping was unsuccessful.
METHODS: This retrospective cohort study included 42 patients with grade I or II endometrioid endometrial cancer who underwent hysterectomy with bilateral salpingo-oophorectomy, followed by comprehensive retroperitoneal pelvic lymphadenectomy after failed bilateral SLN mapping. Patients underwent either vNOTES (n = 21) or MCL (n = 21). Demographic characteristics, operative times, perioperative and postoperative complications, pain scores, and quality of recovery-15 (QoR-15) scores were collected and compared between the two groups.
RESULTS: Demographic and clinical characteristics were comparable between the two groups, with no statistically significant differences. Operative times were significantly longer in the vNOTES group (53.8 ± 7.4 min) compared to the MCL group (46.9 ± 9.2 min; P = 0.01), whereas estimated blood loss (17.7 ± 5.6 mL vs. 18.8 ± 5.0 mL; P = 0.50) and lymph node yield (32.1 ± 6.6 vs. 35.0 ± 8.1; P = 0.21) did not differ significantly. Postoperative pain assessed by visual analogue scale (VAS) was lower in the vNOTES group at 6 h (4.3 ± 1.1 vs. 5.5 ± 1.0; P = 0.01), 12 h (3.5 ± 0.8 vs. 4.8 ± 1.1; P < 0.001), and 24 h (2.1 ± 0.6 vs. 3.1 ± 0.9; P < 0.001). These findings were corroborated by the faces pain scale-revised (FPS-R), which demonstrated significantly lower pain in the vNOTES group at all time points. QoR-15 scores at 48 h were higher in the vNOTES group (109.3 ± 4.7 vs. 104.9 ± 4.1; P = 0.002), indicating improved postoperative recovery. The observed mean difference of approximately 4.4 points remained below the reported minimal clinically important difference of 8.0 points for this instrument, indicating that the statistically significant benefit should be interpreted with caution regarding its clinical magnitude.
CONCLUSION: vNOTES for complete pelvic lymphadenectomy offers reduced postoperative pain, scar-free surgery, and enhanced recovery while maintaining staging adequacy comparable to MCL. Future prospective, multicentre, randomised trials with long-term oncologic follow-up are required to validate these findings.
PMID:42477715 | DOI:10.1186/s12905-026-04698-3
