Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025 Jun;51(6):e16345.
doi: 10.1111/jog.16345.

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

Kemal Güngördük  1 , Varol Gülseren  2 , Berican Şahin Uyar  3 , Özgün Akbaş  4 , Serkan Üstüntaş  3 , Emre Biton  3 , İsa Aykut Özdemir  5
Affiliations
Multicenter Study

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

Kemal Güngördük et al. J Obstet Gynaecol Res. 2025 Jun.

Abstract

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.

Keywords: enlarged uterus; hysterectomy; laparoscopy; vaginal natural orifice transluminal endoscopic surgery.

PubMed Disclaimer

References

REFERENCES

    1. Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med. 1993;328(12):856–860.
    1. Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): feasibility of an innovative approach. Taiwan J Obstet Gynecol. 2012;51(2):217–221.
    1. Aarts JW, Nieboer TE, Johnson N, Tavender E, Garry R, Mol BW, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;2015(8):CD003677.
    1. Yang CY, Shen TC, Lin CL, Chang YY, Huang CC, Lin WC. Surgical outcomes of hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) compared with laparoscopic total hysterectomy (LTH) in women with non‐prolapsed and benign uterine diseases. Taiwan J Obstet Gynecol. 2020;59(4):565–569.
    1. Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial. BJOG. 2019;126(1):105–113.

Publication types

LinkOut - more resources