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
. 2025 Nov;132(12):1810-1816.
doi: 10.1111/1471-0528.18307. Epub 2025 Jul 18.

The Introduction of the vNOTES Hysterectomy in The Netherlands: A Nationwide Cohort Study

Hilde M M Sluijter  1 , Ilse P W Bekkers  2   3 , Rebecca Henschen  2   3 , Marcel van Alphen  4 , Inge Ebisch  5 , Helen S Kok  6 , Julien Labrie  7 , Sanne A L van Leijsen  8 , Angéle L M Oei  9 , Louisette W Peters  10 , Brenda M Pijlman  11 , J Marko Sikkema  12 , Matthieu Y van der Vlist  13 , Kevin G J A Voogdt  14 , Nikki Vos  15 , Jorien M Woolderink  16 , Nicol A C Smeets  2 , Anne Damoiseaux  1 , Aleida G Huppelschoten  1 , Martine L H Wassen  2 , Huib A A M van Vliet  1   17
Affiliations

The Introduction of the vNOTES Hysterectomy in The Netherlands: A Nationwide Cohort Study

Hilde M M Sluijter et al. BJOG. 2025 Nov.

Abstract

Objective: This study aims to assess the peri- and postoperative outcomes of the vNOTES hysterectomy in the Netherlands during implementation.

Study design: Nationwide cohort study.

Setting: vNOTES hysterectomies performed in the Netherlands by 15 hospitals since the implementation of the technique, from August 2019 to September 2024.

Population: 673 patients undergoing vNOTES hysterectomy.

Methods: Descriptive data are presented as frequencies with percentage or mean with range. Logistic regression was used to assess the risk of conversions/complications per BMI group.

Main outcome measures: Peri- and postoperative outcomes such as operating time, conversions, and complications.

Results: The mean operating time was 67.4 min (range 24-210). There were 37 (5.5%) conversions and 94 (15.5%) complications. Nineteen (2.8%) complications were perioperative, and 75 (12.7%) postoperative. Ten (1.5%) of the perioperative complications were classified as Clavien-Dindo (CD) 1, and nine (1.3%) as CD3. Postoperatively, 18 patients (3.1%) had a reintervention (N = 17 CD3, N = 1 CD4), and two (0.3%) patients were admitted to the intensive care unit (CD4). The mean blood loss was 127 mL (range 50-2000), and 220 (37%) of patients were discharged the same day.

Conclusions: This large nationwide cohort study during implementation of the vNOTES hysterectomy demonstrates the safety and feasibility of this upcoming technique, reporting on a short surgery duration and a similar complication percentage compared to other methods of hysterectomy.

Keywords: complications; vNOTES hysterectomy; vaginal‐assisted NOTES hysterectomy.

PubMed Disclaimer

References

    1. F. Tummers, J. Hoebink, S. R. C. Driessen, F. W. Jansen, and A. R. H. Twijnstra, “Decline in Surgeon Volume After Successful Implementation of Advanced Laparoscopic Surgery in Gynecology: An Undesired Side Effect?,” Acta Obstetricia et Gynecologica Scandinavica 100, no. 11 (2021): 2082–2090.
    1. J. W. Aarts, T. E. Nieboer, N. Johnson, et al., “Surgical Approach to Hysterectomy for Benign Gynaecological Disease,” Cochrane Database of Systematic Reviews 2015, no. 8 (2015): CD003677.
    1. C. M. Pickett, D. D. Seeratan, B. W. J. Mol, et al., “Surgical Approach to Hysterectomy for Benign Gynaecological Disease,” Cochrane Database of Systematic Reviews 8, no. 8 (2023): CD003677.
    1. J. Baekelandt and S. Kapurubandara, “Benign Gynaecological Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): Complication Data From a Series of 1000 Patients,” European Journal of Obstetrics, Gynecology, and Reproductive Biology 256 (2021): 221–224.
    1. L. Vacca, E. Rosato, R. Lombardo, et al., “Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Urogynecological Surgery: A Systematic Review,” Journal of Clinical Medicine 13, no. 19 (2024): 5707.