{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T16:04:31Z","timestamp":1779725071704,"version":"3.53.1"},"reference-count":100,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Aim: The purpose of this study was to investigate the safety, efficacy, and clinical outcomes of the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in patients suffering from gynecological cancer. Methods: A systematic review of the literature was conducted from inception to October 2025 following the PRISMA guidelines. PubMed, Google Scholar, and the Cochrane Library were searched for studies investigating vNOTES in gynecological malignancies. Study quality was evaluated using the Newcastle\u2013Ottawa Scale, the National Institute of Health and the Joanna Briggs Institute critical appraisal tools. Results: The search identified 11 observational cohort studies, 28 case series, and 22 case reports. A total of 926 patients with suspected or confirmed gynecologic malignancies underwent surgery via vNOTES approach. The combination of hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy represented the most commonly performed surgical procedure. Endometrial cancer was the most frequent oncological indication. The included studies evaluated the perioperative outcomes, including operative time, estimated blood loss, lymph node assessment, conversion rates and complications. Conclusions: The vNOTES approach appeared to be feasible and at least non-inferior to standard surgical treatments for patients with early-stage gynecologic malignancies. However, the small sample sizes and heterogeneity among studies limit the strength of the evidence and preclude definitive conclusions.<\/jats:p>","DOI":"10.3390\/jcm15114089","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T15:05:08Z","timestamp":1779721508000},"page":"4089","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Patients with Gynecological Malignancies: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"given":"Aristotelis-Marios","family":"Koulakmanidis","sequence":"first","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Kontogeorgi","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5099-9452","authenticated-orcid":false,"given":"Dimitrios","family":"Zacharakis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4250-1853","authenticated-orcid":false,"given":"Anastasia","family":"Prodromidou","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioakeim","family":"Sapantzoglou","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Mascellino","sequence":"additional","affiliation":[{"name":"Unit of Obstetrics and Gynecology, \u201cPaolo Giaccone\u201d Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 901 27 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Kypriotis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0031-809X","authenticated-orcid":false,"given":"Nikolaos","family":"Kathopoulis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3272-202X","authenticated-orcid":false,"given":"Dimos","family":"Sioutis","sequence":"additional","affiliation":[{"name":"3rd Department of Obstretrics and Gyneocology, Attikon Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9477-7619","authenticated-orcid":false,"given":"Charalampos","family":"Voros","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynaecology, Alexandra 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Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"04155","DOI":"10.7189\/jogh.14.04155","article-title":"Global burden of gynaecological cancers in 2022 and projections to 2050","volume":"14","author":"Zhu","year":"2024","journal-title":"J. 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