{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:11:05Z","timestamp":1791875465438,"version":"4.3.4"},"reference-count":16,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2024,4,23]],"date-time":"2024-04-23T00:00:00Z","timestamp":1713830400000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Gorthon Foundation","award":["2022-2823"],"award-info":[{"award-number":["2022-2823"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,4,8]]},"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hysterectomy is one of the most common surgeries performed in women. Minimally invasive methods are on the rise globally as they have been shown to decrease surgical morbidity compared with abdominal hysterectomy. Hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) is the latest innovation. It combines the vaginal approach and endoscopy via the vagina. Large pragmatic randomised controlled trials (RCTs) are lacking comparing outcomes after vNOTES, vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Multicentre pragmatic RCT aiming to recruit 1000\u2009women aged 18\u201375 years undergoing hysterectomy for benign disease. The RCT includes two identical substudies (groups A and B). If VH is considered safe and feasible, the patient will be randomised within group A (VH vs vNOTES). If VH is not considered safe or feasible, patients will be randomised within group B (LH vs vNOTES).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Analysis<\/jats:title>\n                    <jats:p>Primary outcome is the proportion of women leaving the hospital within 12 hours after surgery. Secondary outcomes are hospitalisation time, conversion rates, duration of the surgical procedure, intraoperative complications, postoperative complications and readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The Ethical Board Committee at Imelda Hospital, Bonheiden, Belgium, has approved the research protocol 230704 (principal investigator). Before including patients, all centres will require local or national ethical approval. The results of the study will be published in international peer-reviewed journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT05971875\">NCT05971875<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-081979","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T03:35:27Z","timestamp":1713929727000},"page":"e081979","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["VaNoLaH trial: a study protocol\u2014a multinational randomised controlled trial including two identical substudies comparing vaginal versus vNOTES (vaginal natural orifice transluminal surgery) hysterectomy or laparoscopic versus vNOTES hysterectomy"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct05971875","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8344-8622","authenticated-orcid":false,"given":"Jan Filip","family":"Baekelandt","sequence":"first","affiliation":[{"name":"Imeldaziekenhuis, Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5131-6297","authenticated-orcid":false,"given":"Andrea","family":"Stuart","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden"},{"name":"Department of Obstetrics and Gynecology, Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Wagenius","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, Lund University Department of Clinical Sciences Lund, Lund, Sweden"},{"name":"Department of Obstetrics and Gynecology, Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annouschka","family":"Laenen","sequence":"additional","affiliation":[{"name":"Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8337-550X","authenticated-orcid":false,"given":"Ben W","family":"Mol","sequence":"additional","affiliation":[{"name":"OB\/GYN, School of Medicine, Monash University, Melbourne, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Deprest","sequence":"additional","affiliation":[{"name":"Gynaecology, University Hospital Leuven, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan J A","family":"Bosteels","sequence":"additional","affiliation":[{"name":"Imeldaziekenhuis, Bonheiden, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,4,23]]},"reference":[{"key":"2025121408542195000_14.4.e081979.1","doi-asserted-by":"crossref","unstructured":"Aarts JWM , Nieboer TE , Johnson N , et al . 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