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

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.