{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:35:13Z","timestamp":1789133713105,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T00:00:00Z","timestamp":1670889600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this study is to evaluate the initial feasibility, safety, and outcomes of hysterectomy performed by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) at three institutions in Italy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>All women who underwent vNOTES hysterectomy \u00b1 salpingo-oophorectomy for benign indications at three tertiary referral medical centers between July 2019 and April 2021 were included in a retrospective analysis. All vNOTESs were performed with the use of Alexis<jats:sup>\u00ae<\/jats:sup> and Vpath Gel paths<jats:sup>\u00ae<\/jats:sup> (Applied Medical). Perioperative data were extracted from patient records. Patient satisfaction and dyspareunia were prospectively inquired about at 60 days and 6 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty-six patients underwent vNOTES in the study period. Indications for surgery included myomas \u00b1 metrorrhagia (52.2%), H-Sil\/<jats:italic>in situ<\/jats:italic> cervical cancer (10.7%), adenomyosis \u00b1 metrorrhagia (8.7%), BRCA 1-2 mutations (6.5%), endometrial hyperplasia (6.5%), ovarian cyst + history of breast cancer (6.5%), metrorrhagia (6.5%), and hydatidiform mole (2.2%). The mean operation time was 91.1 (\u00b132.6) minutes. The mean hemoglobin drop was 1.2 (\u00b10.8). The mean visual analog scale at 24 h for post-operative pain was 3.3 (\u00b11.8). Secondary to our limited experience with the surgical technique, we favor discharge only from day 1. The mean length of hospital stay was 2 (\u00b11.4) days. Two conversions to conventional laparoscopy were reported (4.3%), due to an obliterated pouch of Douglas and a preoperative complication. Two post-operative complications were reported (4.3%). Overall, our data on peri- and post-operative outcomes are similar to those already published for vNOTES.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our initial experience suggests that introducing vNOTES as an alternative to conventional surgery is feasible and may offer some advantages in selected women.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2022.1018232","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T04:34:25Z","timestamp":1670906065000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery: An Italian initial experience"],"prefix":"10.3389","volume":"9","author":[{"given":"Maria Lieta","family":"Interdonato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Scollo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Bignardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Massimello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Ferrara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Donatiello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Caretto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Mannella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basilio","family":"Pecorino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Giuseppe","family":"Meroni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Simoncini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1634\/theoncologist.11-8-895","article-title":"Role of minimally invasive surgery in gynecologic cancers.","volume":"11","author":"Schlaerth","year":"2006","journal-title":"Oncologist."},{"key":"B2","doi-asserted-by":"publisher","first-page":"CD003677","DOI":"10.1002\/14651858.CD003677.pub5","article-title":"Surgical approach to hysterectomy for benign gynaecological disease.","volume":"2015","author":"Aarts","year":"2015","journal-title":"Cochrane Datab Syst Rev."},{"key":"B3","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1111\/j.1525-1438.2007.01045.x","article-title":"Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis.","volume":"18","author":"Medeiros","year":"2008","journal-title":"Int J Gynecol Cancer."},{"key":"B4","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1016\/S0016-5107(04)01309-4","article-title":"Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity.","volume":"60","author":"Kalloo","year":"2004","journal-title":"Gastrointest Endoscopy."},{"key":"B5","article-title":"Per oral transgastric endoscopic appendectomy in human.","author":"Reddy","year":"2004","journal-title":"Proceedings of the 45th Annual Conference of the Society of Gastrointestinal Endoscopy of India."},{"key":"B6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/j.1464-410X.2012.11494.x","article-title":"Natural orifice transluminal endoscopic surgery (NOTES): where are we going? 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