The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients.

Aim: This study aimed to compare the surgical outcomes of total laparoscopic hysterectomy (TLH) and vaginally assisted natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy procedures in obese patients.

Materials And Methods: This cross-sectional study was conducted with 83 obese women (BMI > 30 kg/m) who underwent TLH (35 patients) or vNOTES hysterectomy (48 patients) for benign gynecological indications. The duration of surgery, intra/postoperative complications, intra- and postoperative hemoglobin (Hb) and hematocrit (Hct) levels, hospital stay, Visual analogue scale (VAS) scores at the postoperative 6th and 24th hours of the patients were compared.

Results: There was no significant difference between TLH and vNOTES groups regarding age (49 vs. 52 years,  = 0.35), parity (2 vs. 3,  = 0.17), and uterine weight (290 vs. 230 g.,  = 0.13) The median BMI was 31.6 kg/m (30-42.2 kg/m) in the TLH group and 31.9 kg/m (30-54.6 kg/m) in the vNOTES group ( = 0.31). The vNOTES hysterectomy group had significantly shorter durations of surgery (67.5 vs. 136 min) and postoperative hospitalization than the TLH group ( < 0.05 for all comparisons). Besides, the 6th-hour (6 vs. 7,  = 0.02) and 24th-hour (4 vs. 3,  < 0.001) VAS scores were significantly lower in the vNOTES hysterectomy group. The propensity-matched group analysis showed significantly lower 6th-hour and 24th-hour VAS scores and shorter duration of surgery (80 vs. 135 min,  < 0.001) in the vNOTES hysterectomy group than the TLH group.

Conclusion: vNOTES is a feasible technique in obese women who require a hysterectomy and provides favorable outcomes considering the shorter duration of surgery and postoperative hospitalization and lower pain scores.