Benign hastalıkların zor vakalarında V-NOTES histerektomi: ilk 30 vakanın analizi

Öz

Amaç: Bu çalışma, kliniğimizde benign nedenlerle v-NOTES (vajinal - doğal yoldan translüminal endoskopik cerrahi) histerektomi uygulanan ilk 30 hastanın verilerini retrospektif olarak değerlendirmeyi amaçlamaktadır. Minimal invaziv bir cerrahi yöntem olan v-NOTES; daha az ağrı, azalmış kan kaybı ve kozmetik avantajlar sunmaktadır. Çalışmanın birincil amacı v-NOTES yönteminin fizibilitesini, güvenilirliğini ve etkinliğini; ikincil amacı ise cerrahi sonuçlarını değerlendirmektir. Gereç ve Yöntemler: Çalışmaya 40-75 yaş arası, benign hastalık nedeniyle elektif histerektomi kararı alınan ve preoperatif değerlendirmelerde malignite saptanmayan hastalar dahil edildi. Operasyon süresi, uterus ağırlığı, hastanede kalış süresi, komplikasyon oranları ve ilk 30 gün içindeki hastaneye yeniden başvuru oranları analiz edildi. Bulgular: Bulgular, v-NOTES histerektominin düşük komplikasyon oranları ve hızlı iyileşme süreci ile güvenli ve etkili bir yöntem olduğunu göstermektedir. Sonuçlar: Bu teknik, deneyimli cerrahlar tarafından uygulandığında büyük uterus, obezite ve nulliparite gibi zor vakalarda bile başarılı sonuçlar vermektedir. V-NOTES eğitimi almış ve laparoskopi konusunda deneyimli cerrahlar tarafından gerçekleştirildiğinde, başlangıç öğrenme aşamasında dahi zor vakalar düşük komplikasyon oranlarıyla yönetilebilir.

Anahtar Kelimeler

• V-Notes
• histerektomi
• over kistleri
• myom

V-NOTES hysterectomy in challenging cases of benign diseases: insights from the initial 30 cases

Öz

Aim: This study retrospectively evaluated the data of the first 30 patients who underwent v-NOTES (vaginal natural orifice transluminal endoscopic surgery) hysterectomy for benign disease in our clinic. As a minimally invasive surgical method, v-NOTES offers advantages such as less pain, reduced blood loss, and cosmetic benefits. The primary aim was to assess the feasibility, safety, and effectiveness of the v-NOTES method. The secondary aim was to evaluate the surgical outcomes of the method. Material and Methods: Patients included were aged 40-75, had elective hysterectomy decisions for benign disease, and no malignancy was detected in preoperative evaluations. The study evaluated operation time, uterine weight, hospital stay duration, complication rates, and readmission rates within 30 days. Results: The results demonstrate that v-NOTES hysterectomy is a safe and effective method with low complication rates and a rapid recovery process. Conclusion: When performed by experienced surgeons, this technique yields successful outcomes even in cases of large uterus, obesity, and nulliparity. If the operation is performed by surgeons trained in v-NOTES and experienced in laparoscopy, even challenging cases can be managed with low complication rates, even during the initial learning phase.

Anahtar Kelimeler

• V-Notes
• histerektomi
• over kistleri
• myom

Etik Beyan

This study was approved by Kütahya Health Sciences University, Clinical Research Ethics Committee (Approval Number-Date: 2025/10-36-11.08.2025),

Kaynakça

1. Gorina Y, Elgaddal N, Weeks JD. Hysterectomy Among Women Age 18 and Older: United States, 2021. NCHS Data Brief. 2024; 494: 1-8.
2. Rahman R, Gupta S, Manyonda I. Hysterectomy for benign gynaecological disease. Obstet Gynaecol Reprod Med2017; 27: 125-31.
3. Pickett CM, Seeratan DD, Mol BWJ, Nieboer TE, Johnson N, Bonestroo T, Aarts JW. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2023; 8: CD003677.
4. Druenne J, Presles E, Corsini T, Campagne Loiseau S, Curinier S, Mansour A, et al. vNOTEsHC: Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopic for large uteri: study protocol for a multicentre randomised controlled trial. Facts Views Vis Obgyn. 2023; 15: 277-21.
5. Kaya C, Yıldız Ş, Alay İ, Karakaş S, Durmuş U, Güraslan H, Ekin M. Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended- Enlarged Uteri. J Invest Surg. 2022; 35: 918-23.
6. Lowenstein L, Baekelandt J, Paz Y, Lauterbach R, Matanes E. Transvaginal Natural Orifice Transluminal Endoscopic Hysterectomy and Apical Suspension of the Vaginal Cuff to the Uterosacral Ligament. J Minim Invasive Gynecol. 2019; 26: 1015.
7. Baekelandt J, Kapurubandara S. Benign Gynaecological procedures by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): Complication data from a series of 1000 patients. Eur J Obstet Gynecol Reprod Biol. 2021; 256: 221-4.
8. Li CB, Hua KQ. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgeries: A systematic review. Asian J Surg. 2020; 43: 44-51.

9. Baekelandt J, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. "HALON-hysterectomy by transabdominal laparoscopy or natural orifice transluminal endoscopic surgery: a randomised controlled trial (study protocol)." BMJ open 2016: e011546.
10. Housmans S, Stuart A, Bosteels J, Deprest J, Baekelandt J. Standardized 10-step approach for successfully performing a hysterectomy via vaginal natural orifice transluminal endoscopic surgery. Acta Obstet Gynecol Scand. 2022; 101: 649-56.
11. Kovac SR, Barhan S, Lister M, Tucker L, Bishop M, Das A. Guidelines for the selection of the route of hysterectomy: application in a resident clinic population. Am J Obstet Gynecol. 2002; 187: 1521-7.
12. AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treat benign uterine disease. J Minim Invasive Gynecol. 2011; 18: 1-3.
13. Committee Opinion No. 701 Summary: Choosing The Route Of Hysterectomy For Benign Disease. Obstet Gynecol. 2017; 129: 1149-50.
14. Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, et al. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: a randomised controlled trial. BJOG. 2019; 126: 105-13.
15. Raquet J, Namèche L, Nisolle M, Closon F. The revival of vaginal surgery in the era of endoscopy: V-NOTES initial experience with a series of 32 patients. Facts Views Vis Obgyn. 2023; 15: 69-78.
16. Wang CJ, Go J, Huang HY, Wu KY, Huang YT, Liu YC, Weng CH. Learning curve analysis of transvaginal natural orifice transluminal endoscopic hysterectomy. BMC Surg. 2019; 19: 88.
17. Stuart A, Wagenius J, Badiglian-Filho L, Schnabel J, Montealegre A, Ehrström S, et al. Intra- and Postoperative Complications in 4565 vNOTES Hysterectomies: International Registry Cohort Study. BJOG. 2025; 132: 464-72.
18. Gungorduk K, Akpak YK, Erkılınc S, Sacinti KG, Korkmaz V, Iscan SC, et al. Outcomes of transvaginal natural orifice transluminal endoscopic hysterectomy: a multi-centre retrospective study from Turkey (TR-MIGS). J Obstet Gynaecol. 2025; 45: 2548809.