{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T22:40:17Z","timestamp":1778712017751,"version":"3.51.4"},"reference-count":19,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>In this study, the application of vaginal natural orifice transluminal endoscopic surgery (vNOTES) and conventional laparoscopy (CLS) underwent hysterectomy in patients with enlarged uterus was compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This multicenter study enrolled patients with an enlarged uterus (\u2265300\u2009g) who underwent minimally invasive hysterectomy using either CLS or vNOTES in the Department of Obstetrics and Gynecology between January 2020 and December 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the enrolled patients with an enlarged uterus, 39 (65.0%) underwent conventional laparoscopy, and 21 (35.0%) underwent vNOTES. The median operative times were 80 (50\u2013140) min in the conventional laparoscopy group and 70 (60\u2013130) min in the vNOTES group (<jats:italic>p<\/jats:italic>\u2009=\u20090.008). Median blood loss was significantly lower in the vNOTES group (140 [80\u2013210] vs. 160 [90\u2013370] mL; <jats:italic>p<\/jats:italic>\u2009=\u20090.013). The length of hospital stay was comparable between groups. Intraoperative bladder injury occurred in one patient in each group\u2014conventional laparoscopy (2.6%) and vNOTES (4.8%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.651). Conversion to laparotomy was required in three patients (7.7%) in the CLS group and one patient (4.8%) in the vNOTES group (<jats:italic>p<\/jats:italic>\u2009=\u20090.664). The visual analog scale pain score was significantly lower in the vNOTES group at 6, 12, and 24\u2009h postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>vNOTES was confirmed to be a safe, feasible, and effective approach for hysterectomy in patients with an enlarged uterus.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jog.16345","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T01:58:21Z","timestamp":1750384701000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Can vaginal natural orifice transluminal endoscopic surgery hysterectomy be performed in patients with an enlarged uterus?"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2325-1756","authenticated-orcid":false,"given":"Kemal","family":"G\u00fcng\u00f6rd\u00fck","sequence":"first","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0779-8305","authenticated-orcid":false,"given":"Varol","family":"G\u00fclseren","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, School of Medicine \u0130zmir Katip \u00c7elebi University  \u0130zmir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1463-7021","authenticated-orcid":false,"given":"Berican \u015eahin","family":"Uyar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine Mu\u011fla S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla 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S\u0131tk\u0131 Ko\u00e7man University  Mu\u011fla Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5457-3312","authenticated-orcid":false,"given":"\u0130sa Aykut","family":"\u00d6zdemir","sequence":"additional","affiliation":[{"name":"Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Medipol University  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199303253281207"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjog.2012.04.009"},{"issue":"8","key":"e_1_2_8_4_1","first-page":"CD003677","article-title":"Surgical approach to hysterectomy for benign gynaecological disease","volume":"2015","author":"Aarts JW","year":"2015","journal-title":"Cochrane Database Syst 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