Hysterectomy using the vNOTES technique. Experience from a highly specialized center

Víctor Alejandro Rubio García, Carlos Leal Meléndez, Jorge Rodríguez Avalos, Marco Antonio Guzmán Aguilar, Yousset Alexis García Hernández, Valentín Tovar Galván, Juan Gustavo Vázquez Rodríguez
2025 · doi:10.5281/zenodo.15429182 · W6930624296
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This retrospective cohort study of 20 patients found that vNOTES hysterectomy for uterine pathologies, including adenomyosis, was a safe procedure with minimal complications, low blood loss, and short hospital stays.

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This retrospective cohort study evaluated the safety and efficacy of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in a small group of 20 patients with various uterine pathologies. The procedure demonstrated favorable outcomes, including a mean surgical time of 60 minutes, low estimated blood loss, zero complications, and minimal postoperative pain scores over seven days. Although the sample size is limited, the authors conclude that vNOTES is a safe alternative to conventional techniques for selected cases. Relevance to endometriosis: adenomyosis is listed as one of the specific uterine pathologies included in the patient cohort, though the paper's primary focus remains on the surgical technique itself rather than disease-specific management.

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Abstract

Background: Natural orifice transluminal endoscopic vaginal surgery (vNOTES) is a successful alternative procedure to conventional hysterectomy techniques. Objective: To analyze the results of hysterectomy with the vNOTES technique in a cohort of patients with uterine pathology. Material and methods: Cross-sectional study in a retrospective cohort of 20 patients with uterine pathology undergoing hysterectomy with the vNOTES technique in the Department of Minimally Invasive Surgery in Gynecology of a Hospital in the city of Chihuahua, Mexico from April 1, 2022 to March 31, 2023. The records were consulted to know the general data, uterine pathology, technical characteristics of vNOTES (surgical time, estimated bleeding, complications, conversions to other techniques, complementary procedures), hospital stay, mortality, antibiotic therapy, outpatient analgesia and evaluation of postoperative pain with the Visual Analog Scale (VAS score). Results: Age 43.5±5.56 years and obesity 15%. Previous surgeries: cesarean section 30%, bilateral tubal occlusion 25% and laparotomy/laparoscopy 25%. Uterine pathology: leiomyomatosis of large elements 75%, adenomyosis 10%, uterine prolapse grade-II 5%, endometrial hyperplasia without atypias 5% and cervical dysplasia CIN-II 5%. Scheduled vNOTES 100%, single procedure 95% and complemented with abdominal laparoscopy 5%. Surgical time 60 minutes, uterine weight 292.08 g, estimated bleeding 70 ml, complications 0%, reoperations 0%, hospital stay 1.09 days and mortality 0%. Medications: oral cephalexin 100%, oral ketorolac with paracetamol 100%. VAS score: day 1=2, day 3=1, day 7=0. Conclusions: The results of vNOTES hysterectomy are successful. It is a safe surgical alternative with minimal adverse effects. Keywords: Hysterectomy; vNOTES hysterectomy; Uterine pathology.
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Background

Natural orifice transluminal endoscopic vaginal surgery (vNOTES) is a successful alternative procedure to conventional hysterectomy techniques.

Objective

To analyze the results of hysterectomy with the vNOTES technique in a cohort of patients with uterine pathology.

Material and methods

Cross-sectional study in a retrospective cohort of 20 patients with uterine pathology undergoing hysterectomy with the vNOTES technique in the Department of Minimally Invasive Surgery in Gynecology of a Hospital in the city of Chihuahua, Mexico from April 1, 2022 to March 31, 2023. The records were consulted to know the general data, uterine pathology, technical characteristics of vNOTES (surgical time, estimated bleeding, complications, conversions to other techniques, complementary procedures), hospital stay, mortality, antibiotic therapy, outpatient analgesia and evaluation of postoperative pain with the Visual Analog Scale (VAS score).

Results

Age 43.5±5.56 years and obesity 15%. Previous surgeries: cesarean section 30%, bilateral tubal occlusion 25% and laparotomy/laparoscopy 25%. Uterine pathology: leiomyomatosis of large elements 75%, adenomyosis 10%, uterine prolapse grade-II 5%, endometrial hyperplasia without atypias 5% and cervical dysplasia CIN-II 5%. Scheduled vNOTES 100%, single procedure 95% and complemented with abdominal laparoscopy 5%. Surgical time 60 minutes, uterine weight 292.08 g, estimated bleeding 70 ml, complications 0%, reoperations 0%, hospital stay 1.09 days and mortality 0%. Medications: oral cephalexin 100%, oral ketorolac with paracetamol 100%. VAS score: day 1=2, day 3=1, day 7=0.

Conclusions

The results of vNOTES hysterectomy are successful. It is a safe surgical alternative with minimal adverse effects.

Keywords

Hysterectomy; vNOTES hysterectomy; Uterine pathology. Files RUBIO_VNOTES_2025.pdf Files (3.4 MB) | Name | Size | Download all | |---|---|---| | md5:04a19527751ae9009823de3ec8b544c8 | 3.4 MB | Preview Download |

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