ACOG Conference Coverage

Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy May Offer Alternative to Traditional Approaches

Kate Young

Key Highlights:

  • Hysterectomies performed using vaginal natural orifice transluminal endoscopic surgery (vNOTES) demonstrated the lowest average blood loss compared with vaginal and laparoscopic approaches.
  • Women who underwent vNOTES procedures reported significantly less pain interference in the early postoperative period.
  • Physical function recovery was superior or comparable for vNOTES and vaginal hysterectomy over total laparoscopic hysterectomy.

Vaginal natural orifice transluminal endoscopic surgery hysterectomy (vNOTES-H) may offer meaningful clinical advantages over traditional hysterectomy approaches. In a prospective study presented at the 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical & Scientific Meeting in Minneapolis, MN, women undergoing vNOTES-H experienced reduced early postoperative pain and demonstrated superior or comparable physical function outcomes when measured against vaginal hysterectomy (VH) and total laparoscopic hysterectomy (TLH). Notably, vNOTES procedures were associated with the lowest average blood loss among the surgical modalities assessed.

While the ACOG endorses the vaginal approach as the preferred method of hysterectomy, the advent of vNOTES offers a minimally invasive alternative that may retain the advantages of vaginal surgery while expanding visualization and access.

In this study, researchers enrolled women over 21 years of age who were scheduled to undergo vNOTES-H, VH, or TLH at the University of Puerto Rico and Oasis Women Medical Center. Clinical data were extracted through chart reviews and patient interviews. The PROMIS system was used to assess pain interference and physical function on postoperative days 1, 7, and 42. Descriptive statistics and standardized T-scores facilitated the analysis.

Among the 42 patients included (mean age 54), abnormal uterine bleeding was the most common surgical indication. No major complications occurred across all groups. Average blood loss was lowest in the vNOTES-H group (120 mL). Pain interference scores for patients undergoing vNOTES-H were lower on day 1 (T = 59.6) and day 7 (T = 53.5), aligning with VH scores by day 42 (T = 47.8). In terms of physical function, both patients undergoing vNOTES-H and those undergoing VH outperformed patients who underwent TLH across all time points: day 1 (T=40.4 and 40.3), day 7 (T = 44.4 and 45.0), and day 42 (T = 50 for both).

“Women subjected to vNOTES-H could benefit from the same outcomes granted by VH with a lower risk for injury,” the researchers concluded. “vNOTES-H potentially challenges guidelines given its modern advances. Further research is vital for characterizing the novel technique.”

Reference:
Cárdenas-Suárez N, Gonzalez-Castillo K, Romaguera J, Santos-Santos F, Vazquez MA. vNOTES hysterectomies as a challenge for current guidelines regarding benign disease. Presented at: ACOG Annual Clinical & Scientific Meeting; May 2025; Minneapolis, MN.