Comparison of vaginal natural orifice transluminal endoscopic surgery and vaginal hysterectomy for benign indications: a prospective randomized controlled study

Yıldız, Gazi; Keles, Esra; Yıldız, Pınar; Dereli, Murat Levent; Kırlangıç, Mehmet Mete; Turan, Kasım; Sargın, Bahadır Alper; Mat, Emre

doi:10.1590/1806-9282.20250948

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Original Article • Rev. Assoc. Med. Bras. 71 (11) • 2025 • https://doi.org/10.1590/1806-9282.20250948 linkcopy

Comparison of vaginal natural orifice transluminal endoscopic surgery and vaginal hysterectomy for benign indications: a prospective randomized controlled study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE: The aim of the study was to compare the surgical outcomes of vaginal natural orifice transluminal endoscopic surgery and conventional vaginal hysterectomy for benign gynecological conditions.

METHODS: A prospective randomized controlled trial was conducted at a tertiary hospital from January 2025 to February 2025. Patients aged 40–80 who underwent hysterectomy for benign indications were included. Outcomes assessed included surgical outcomes, visual analog scale pain scores, and complication rates.

RESULTS: A total of 144 patients were included, with 72 undergoing vaginal natural orifice transluminal endoscopic surgery and 72 undergoing vaginal hysterectomy. No significant differences were found in demographic characteristics, surgical duration (100.8±14.1 min for vaginal natural orifice transluminal endoscopic surgery vs. 99.3±26.7 min for vaginal hysterectomy, p=0.646), or complication rates. The vaginal natural orifice transluminal endoscopic surgery group had a higher rate of bilateral salpingo-oophorectomy (97.2 vs. 36.1%, p<0.001) and required fewer non-steroidal anti-inflammatory drugs postoperatively (median 2.0 vs. 3.0, p=0.003).

CONCLUSION: This study indicates that vaginal natural orifice transluminal endoscopic surgery is a feasible alternative to vaginal hysterectomy for benign hysterectomies, demonstrating comparable outcomes and potential benefits in postoperative pain management. Future multi-center studies are warranted to strengthen the evidence base and explore long-term outcomes.

KEYWORDS:
Natural orifice transluminal endoscopic surgery; Gynecologic surgeries; Pain; Vaginal hysterectomy

		vNOTES hysterectomy group (n=72)	Vaginal hysterectomy group (n=72)	p-value
Age (year, mean±SD)		58.02±9.18	59.27±8.78	0.336
BMI (kg/m²), mean±SD		28.02±4.89	28.13±4.03	0.868
Parity, (median±IQR)		3.5±2.75	4±2	0.092
Post-menopausal, n (%)		60 (83.3)	64 (88.8)	0.190
Co-morbidities, n (%)		41 (56.9)	36 (50)	0.388
	● Hypertension, n (%)	24 (33.3)	21 (29.1)
	● Diabetes mellitus, n (%)	13 (18)	11 (15.2)
	● Coronary artery disease, n (%)	5 (6.9)	4 (5.5)
	● Asthma, n (%)	6 (8.3)	5 (6.9)
	● Hypothyroidism, n (%)	9 (12.5)	8 (11.1)
Operation indication
	● Adenomyosis, n (%)	7 (9.7)	8 (9.6)	0.737
	● Medical treatment resistant abnormal uterine bleeding, n (%)	31 (43)	29 (40.3)
	● Uterine leiomyoma, n (%)	8 (11.1)	10 (13.8)
	● Endometrial hyperplasia without atypia, n (%)	26 (36.1)	25 (34.7)

		vNOTES hysterectomy group (n=72)	Vaginal hysterectomy group (n=72)	p-value
Duration of surgery, min (mean±SD, min–max)		100.8±14.1	99.3±26.7	0.646
Hospitalization time, h (median±IQR, min–max)		43.09±14.8	41.13±16.0	0.080
Re-admission, n (%)		4 (5.5)	2 (2.8)	0.079
Drop in hematocrit levels, % (mean±SD, min–max)		3.91±3	3.48±1.5	0.163
Intraoperative complications, n (%)
	● Bladder injury	1 (1.4)	1 (1.4)	1
Postoperative complications, n (%)		3 (4.2)	2 (2.8)	0.638
	● Postoperative ileus, n (%)	2 (2.8)	–
	● Vaginal bleeding, n (%)	1 (1.4)	2 (2.8)
VAS score at postoperative 6th hour, (median±IQR)		5.5±1	6±1	0.233
VAS score at postoperative 24th hour, (median±IQR)		2±2	2±0	0.111
Total doses of NSAİD analgesics used, (median±IQR)		2±1	3±1	0.003*
Narcotic analgesics requirement, n (%)		0	0	NA

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[TFN1] BMI: body mass index; vNOTES: transvaginal natural orifice transluminal endoscopic surgery; SD: standard deviation; IQR: ınterquartile range.