{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:47:51Z","timestamp":1790736471883,"version":"4.1.0"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T00:00:00Z","timestamp":1731888000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To present the rates of intra\u2010 and postoperative complications and conversions in a large cohort of unselected vNOTES hysterectomies, performed by surgeons with different levels of expertise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>International register\u2010based cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hysterectomies in the iNOTESs registry, 2015 to January 2024, performed by 201 surgeons from multiple countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>4565 patients undergoing vNOTES hysterectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Descriptive data are presented in frequencies (<jats:italic>n<\/jats:italic>) and percent (%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measure<\/jats:title><jats:p>Intra\u2010 and postoperative complications. Conversions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Intraoperative and postoperative complication rates were 3.2% (<jats:italic>n<\/jats:italic>\u2009=\u2009144) and 2.5% (<jats:italic>n<\/jats:italic>\u2009=\u2009115), respectively. Conversions occurred in 1.6% (<jats:italic>n<\/jats:italic>\u2009=\u200972), of which 10 (0.2%) to laparotomy, and 82% of the conversions occurred within the first 50 cases of the surgeon's learning curve. The most common intraoperative complication was cystotomy, occurring in 1.3%, and almost half were performed by inexperienced surgeons. Other intraoperative organ injuries occurred in 20 cases (0.44%). Postoperatively, the most common complications were haemorrhage (<jats:italic>n<\/jats:italic>\u2009=\u200928), vault complications (<jats:italic>n<\/jats:italic>\u2009=\u200926) including 11 infected vault hematomas, cystitis (<jats:italic>n<\/jats:italic>\u2009=\u200918) and non\u2010specific infections (<jats:italic>n<\/jats:italic>\u2009=\u200914). The vNOTES hysterectomies were performed by 201 surgeons, of which 9.5% had performed more than 50 vNOTES cases, representing 70% of the registered cases in the registry. The remaining 30% of the hysterectomies mainly represent learning curve data from 90% of the included surgeons. The complication rate decreased with increasing surgical experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The largest study population of vNOTES hysterectomies is presented, including both learning curve data and data from experienced surgeons, with acceptable rates of intra\u2010 and postoperative complications. No implication was found of vNOTES being inferior to other minimally invasive methods.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18000","type":"journal-article","created":{"date-parts":[[2024,11,18]],"date-time":"2024-11-18T09:28:31Z","timestamp":1731922111000},"page":"464-472","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Intra\u2010 and Postoperative Complications in 4565 <scp>vNOTES<\/scp> Hysterectomies: International Registry Cohort Study"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-6297","authenticated-orcid":false,"given":"Andrea","family":"Stuart","sequence":"first","affiliation":[{"name":"Inst of Clinical Sciences, Department of Obstetrics and Gynecology Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Helsingborg Hospital  Helsingborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Wagenius","sequence":"additional","affiliation":[{"name":"Inst of Clinical Sciences, Department of Obstetrics and Gynecology Lund University  Lund Sweden"},{"name":"Department of Obstetrics and Gynecology Helsingborg Hospital  Helsingborg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Levon","family":"Badiglian\u2010Filho","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology AC Camargo Cancer Center  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Schnabel","sequence":"additional","affiliation":[{"name":"DRK Krankenhaus Chemnitz\u2010Rabenstein  Chemnitz Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Montealegre","sequence":"additional","affiliation":[{"name":"McGovern Medical School, Department of Obstetrics Gynecology and Reproductive Sciences  Houston USA"},{"name":"Division of Minimally Invasive Gynecologic Surgery University of Texas  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia","family":"Ehrstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Division of Obstetrics and Gynaecology, Danderyd Hospital  Stockholm Sweden"},{"name":"Considra Gyn Nacka Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Frauenklinik, MKS St. Paulus GmbH Marienkrankenhaus Schwerte  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jona","family":"Vercammen","sequence":"additional","affiliation":[{"name":"Department of Gynaecology and Obstetrics Heilig Hartziekenhuis  Mol Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Huber","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Sion Hospital  Sion Switzerland"},{"name":"Department of Pediatrics, Obstetrics and Gynecology University of Geneva  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Lingstr\u00f6m","sequence":"additional","affiliation":[{"name":"Inst of Clinical Sciences, Department of Obstetrics and Gynecology Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8344-8622","authenticated-orcid":false,"given":"Jan","family":"Baekelandt","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Imelda Hospital  Bonheiden Belgium"},{"name":"Department of Gynecology and Obstetrics Development and Regeneration, Leuven University  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6841a3"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14367"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15504"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2020.10.059"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471\u20100528.17911"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01921.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15035"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.0001-6349.2004.00450.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9123959"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xagr.2024.100355"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001096"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002414"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-022-05339-7"},{"key":"e_1_2_10_16_1","unstructured":"Swedish Federation of Obstetrics and Gynecology \u201cGuidelines for hysterectomy.\u201d Svensk f\u00f6rening f\u00f6r Obstetrik och Gynekologi. SFOG riktlinje f\u00f6r hysterektomi p\u00e5 benign indikation [Internet]. (2023) https:\/\/www.sfog.se\/media\/338914\/riktlinje\u2010foer\u2010hysterektomi\u2010paa\u2010benign\u2010indikation.pdf."},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003677.pub5"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181c33c72"},{"key":"e_1_2_10_19_1","unstructured":"The Swedish National Quality Register of Gynecological Surgery.\u201cHysterectomy on Benign Indications.\u201dAnnual Report. (Ume\u00e5\u00c5rsrapport Hysterektomi 2023 (gynop.se) 2023)."},{"key":"e_1_2_10_20_1","unstructured":"National Institute for Health and Care Excellence \u201cVaginal Transluminal Endoscopic Hysterectomy and Adnexal Surgery for Benign Gynaecological Conditions \u201d(2023) https:\/\/www.nice.org.uk\/guidance\/ipg774\/resources\/vaginal\u2010transluminal\u2010endoscopic\u2010hysterectomy\u2010and\u2010adnexal\u2010surgery\u2010for\u2010benign\u2010gynaecological\u2010conditions\u2010pdf\u20101899876461756101."},{"issue":"14","key":"e_1_2_10_21_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-081979","article-title":"VaNoLaH Trial: A Study Protocol\u2010a Multinational Randomised Controlled Trial Including Two Identical Substudies Comparing Vaginal Versus vNOTES (Vaginal Natural Orifice Transluminal Surgery) Hysterectomy or Laparoscopic Versus vNOTES Hysterectomy","volume":"23","author":"Baekelandt J. 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