{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:41:03Z","timestamp":1792813263578,"version":"4.5.0"},"reference-count":8,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":262,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Predicting surgical difficulty in vNOTES hysterectomy remains challenging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 49 patients who underwent vNOTES hysterectomy between April 2023 and April 2026. Cases with pelvic organ prolapse and cases with incomplete data were excluded, resulting in 42 evaluable patients. At our institution, patients suspected preoperatively of cul\u2010de\u2010sac obliteration were not considered candidates for vNOTES hysterectomy. The procedure was divided into three phases: transvaginal access, laparoscopic, and closure. Pelvic anatomical parameters (PCL, H line, M line, and H\/PCL ratio) and clinical variables were evaluated using preoperative resting MRI and perioperative surgical records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The H line showed significant negative correlations with operative time in both the transvaginal phase (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.345,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.025) and laparoscopic phase (\n                      <jats:italic>\u03c1<\/jats:italic>\n                      \u2009=\u2009\u22120.413,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007), whereas no significant correlation was observed in the closure phase. In multivariate analysis, the H line showed a consistent negative association with operative time, although statistical significance was not reached.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pelvic anatomy, particularly the H line, is associated with operative difficulty in vNOTES hysterectomy. Resting MRI provides a practical and generalizable assessment method. These findings may aid preoperative evaluation and improve surgical planning and patient selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ases.70382","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T01:31:42Z","timestamp":1789954302000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Preoperative\n                    <scp>MRI<\/scp>\n                    \u2010Based Pelvic Anatomy and Phase\u2010Specific Operative Time in\n                    <scp>vNOTES<\/scp>\n                    Hysterectomy: A Retrospective Study"],"prefix":"10.1111","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7926-8427","authenticated-orcid":false,"given":"Masahiro","family":"Kanamori","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7232-7331","authenticated-orcid":false,"given":"Hiroharu","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko","family":"Ikebata","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3638-8331","authenticated-orcid":false,"given":"Aimi","family":"Oda","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yumi","family":"Shimizu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misa","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Takaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Adachi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Seirei Hamamatsu General Hospital  Hamamatsu Shizuoka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15504"},{"issue":"2","key":"e_1_2_13_3_1","first-page":"280","article-title":"Natural Orifice Transluminal Endoscopic Surgery in Gynecology","volume":"27","author":"Lee C. L.","year":"2020","journal-title":"Journal of Minimally Invasive Gynecology"},{"key":"e_1_2_13_4_1","article-title":"Evaluation of Surgical Outcomes in vNOTES Hysterectomy","volume":"18","author":"Kaya C.","year":"2021","journal-title":"Gynecological Surgery"},{"key":"e_1_2_13_5_1","first-page":"418","article-title":"Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): A Review of Current Evidence","volume":"256","author":"Kapurubandara S.","year":"2021","journal-title":"European Journal of Obstetrics & Gynecology and Reproductive Biology"},{"issue":"3","key":"e_1_2_13_6_1","first-page":"257","article-title":"Rethinking Mechanisms, Diagnosis, and Management of Endometriosis","volume":"25","author":"Chapron C.","year":"2019","journal-title":"Human Reproduction Update"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-023-05707-x"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.179.1.2006286"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16248"}],"container-title":["Asian Journal of Endoscopic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70382","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ases.70382","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70382","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:11:08Z","timestamp":1792811468000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ases.70382"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ases.70382"],"URL":"https:\/\/doi.org\/10.1111\/ases.70382","archive":["Portico"],"relation":{},"ISSN":["1758-5902","1758-5910"],"issn-type":[{"value":"1758-5902","type":"print"},{"value":"1758-5910","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70382"}}