Authors (including presenting author) :
Law HY (1), Lee LTL (1), Law YPJ (1)
Affiliation :
(1) Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital
Keyword 2: :
minimal invasive surgery
Keyword 3: :
laparoscopic hysterectomy
Introduction :
Vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy is an emerging minimally invasive alternative to conventional laparoscopic hysterectomy (TLH), where the abdominal cavity is accessed via the vagina without any external scars. It offers a potential of scarless surgery and enhanced recovery. However, there is a lack of local data regarding its safety and feasibility.
Objectives :
This retrospective cohort study aimed to compare the perioperative outcomes of vNOTES hysterectomy and TLH.
Methodology :
This retrospective matched-cohort study included 84 patients in our department. The vNOTES group comprised 42 patients, representing our initial experience with this novel technique from March 2023 to October 2025. They were matched in a 1:1 fashion to patients who underwent TLH based on age, parity, number of previous vaginal deliveries, number of previous Caesarean sections and uterine weight. To enhance matching quality, the TLH group was selected from a broader period between February 2021 to October 2025. Perioperative outcomes including operating time, estimated blood loss (EBL), decrease in haemoglobin (Hb) level, need of blood transfusion, surgical complications and length of hospital stay, were compared between the groups.
Result & Outcome :
The baseline characteristics were comparable between the two groups regarding age, BMI, number of previous vaginal deliveries and Caesarean sections and uterine weight. The vNOTES group had a greater EBL (195 ml Vs 110 ml, p=0.013) compared to the TLH group. However, there was no significant differences in the decrease in Hb level, need of blood transfusion or operative time. There was no significant difference between the two groups in the occurrence of perioperative complications or hospital readmission within 28 days. vNOTES group had a shorter mean length of stay, but the difference was not statistically significant. In conclusion, the surgical outcomes of vNOTES hysterectomy were comparable to those of TLH. The greater EBL observed in vNOTES could be related to the learning curve of this novel technique, which is anticipated to improve with time. Given its advantage of no visible scar and its trend toward enhanced recovery, vNOTES hysterectomy represents a safe and feasible minimally invasive alternative to TLH. However, further large-scale prospective studies are needed to validate these findings.
