{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T14:41:36Z","timestamp":1768315296359,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Vaginal natural orifice transluminal endoscopic surgery, vNOTES, has become an increasingly preferred minimally invasive option for benign hysterectomy. General anesthesia is still the routine choice, yet regional methods such as combined spinal epidural anesthesia may support a smoother postoperative course. Although the use of vNOTES is expanding, comparative information on anesthetic approaches remains limited, and its unique physiologic setting requires dedicated evaluation. To compare combined spinal epidural anesthesia with general anesthesia for benign vNOTES hysterectomy, focusing on postoperative nausea and vomiting, recovery quality, and intraoperative physiologic safety. Materials and Methods: This retrospective cohort study was conducted in a single center and identified women who underwent benign vNOTES hysterectomy between March 2024 and August 2025 from electronic medical records. Participants received either combined spinal epidural anesthesia or general anesthesia according to routine clinical practice. All patients were managed within an enhanced recovery pathway that incorporated standardized analgesia and prophylaxis for postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting during the first day after surgery. Secondary outcomes included time to discharge from the recovery unit, pain scores at set postoperative intervals, early functional recovery, patient satisfaction and physiologic parameters extracted from intraoperative monitoring records. Analyses were performed according to the anesthesia group documented in the medical files. Results: One hundred forty patients met inclusion criteria and were included in the analysis. Combined spinal epidural anesthesia was linked to a lower incidence of postoperative nausea and vomiting, a shorter stay in the post-anesthesia care unit, and reduced pain scores in the first 24 h (adjusted odds ratio 0.32, ninety five percent confidence interval 0.15 to 0.68). Early ambulation and oral intake were reached sooner in the combined spinal epidural group, with higher overall satisfaction also noted. Adherence to ERAS elements was similar between groups, with no meaningful differences in early feeding, mobilization, analgesia protocols or PONV prophylaxis. During the procedure, combined spinal epidural anesthesia produced more episodes of hypotension and bradycardia, while general anesthesia was linked to higher airway pressures and lower oxygen saturation. Complication rates within the first month were low in both groups. Conclusions: In this observational cohort study, combined spinal epidural anesthesia was associated with lower postoperative nausea, earlier recovery milestones and greater patient comfort compared with general anesthesia. Hemodynamic instability occurred more often with neuraxial anesthesia but was transient and manageable. While these findings point to potential recovery benefits for some patients, the observational nature of the study and the modest scale of the differences necessitate a cautious interpretation. They should be considered exploratory rather than definitive. The choice of anesthesia should therefore be individualized, weighing potential recovery benefits against the risk of transient hemodynamic effects. Larger and more diverse studies are needed to better define patient selection and clarify the overall risk benefit balance. These findings should be interpreted cautiously and viewed as hypothesis-generating rather than definitive evidence supporting one anesthetic strategy over another.<\/jats:p>","DOI":"10.3390\/medicina62010154","type":"journal-article","created":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:17:32Z","timestamp":1768292252000},"page":"154","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Does Regional Anesthesia Improve Recovery After vNOTES Hysterectomy? A Comparative Observational Study"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5300-6536","authenticated-orcid":false,"given":"Kevser","family":"Arkan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kubra Cakar","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2137-2986","authenticated-orcid":false,"given":"Ali Deniz","family":"Erkmen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sedat","family":"Akgol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6520-2357","authenticated-orcid":false,"given":"Gul Cavusoglu","family":"Colak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-0113","authenticated-orcid":false,"given":"Mesut Ali","family":"Haliscelik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fatma","family":"Acil","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3797-8227","authenticated-orcid":false,"given":"Behzat","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21070 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"ref_1","first-page":"33","article-title":"Total vaginal NOTES hysterectomy: A new approach to hysterectomy","volume":"9","author":"Baekelandt","year":"2017","journal-title":"Facts Views Vis. Obgyn."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.ejogrb.2016.10.044","article-title":"Postoperative outcomes and quality of life following hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) compared to laparoscopy in women with a non-prolapsed uterus and benign gynaecological disease: A systematic review and meta-analysis","volume":"208","author":"Baekelandt","year":"2017","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1016\/j.jmig.2023.01.005","article-title":"The Feasibility and Safety of vNOTES Hysterectomy and Uterosacral Ligament Suspension: A Case Series","volume":"30","author":"Farah","year":"2023","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1111\/jog.16083","article-title":"vNOTES scarless and painless endometrial cancer staging surgery","volume":"50","year":"2024","journal-title":"J. Obs. Gynaecol. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1097\/AOG.0b013e3182166055","article-title":"Increasing minimally invasive hysterectomy: Effect on cost and complications","volume":"117","author":"Jonsdottir","year":"2011","journal-title":"Obs. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"186","DOI":"10.4274\/tjod.galenos.2020.28928","article-title":"Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study","volume":"17","author":"Pirbudak","year":"2020","journal-title":"Turk. J. Obs. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1136\/bmj.321.7275.1493","article-title":"Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: Overview of randomized trials","volume":"321","author":"Rodgers","year":"2000","journal-title":"BMJ"},{"key":"ref_8","first-page":"e90483","article-title":"Comparing Regional Anesthesia and General Anesthesia for Postoperative Pain Control in Abdominal Surgeries: A Systematic Review and Meta-Analysis","volume":"17","author":"Alshebly","year":"2025","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2001","DOI":"10.1007\/s00404-022-06727-6","article-title":"Minimally invasive anesthesia for laparoscopic hysterectomy: A case series","volume":"306","author":"Mercorio","year":"2022","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ygyno.2023.04.009","article-title":"ERAS Society guidelines for gynecologic oncology: Implementation challenges-2023 update","volume":"173","author":"Nelson","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_11","first-page":"1661","article-title":"Enhanced recovery after surgery: A review","volume":"41","author":"Ljungqvist","year":"2017","journal-title":"World J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/j.1399-6576.1994.tb03889.x","article-title":"Pneumoperitoneum and cerebral haemodynamics during laparoscopy","volume":"38","author":"Odeberg","year":"1994","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_13","first-page":"1238","article-title":"Physiologic effects of pneumoperitoneum in the morbidly obese","volume":"136","author":"Nguyen","year":"2001","journal-title":"Arch. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/j.1399-6576.1995.tb04203.x","article-title":"Ventilatory effects, blood gases, and oxygenation during laparoscopic hysterectomy","volume":"39","author":"Hirvonen","year":"1995","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1564","DOI":"10.1213\/ANE.0000000000004289","article-title":"Global and Regional Respiratory Mechanics During Robotic-Assisted Laparoscopic Surgery: A Randomized Study","volume":"129","author":"Lessa","year":"2019","journal-title":"Anesth. Analg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.4103\/sja.sja_600_24","article-title":"The impact of pneumoperitoneum and steep Trendelenburg positioning on novel oxygenation and saturation indices in robot-assisted laparoscopic prostatectomies: A prospective observational study","volume":"19","author":"Tontu","year":"2025","journal-title":"Saudi J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/anae.12168","article-title":"Minimum alveolar concentration: Ongoing relevance and clinical utility","volume":"68","author":"Aranake","year":"2013","journal-title":"Anaesthesia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1016\/S0140-6736(11)60245-6","article-title":"Treatment of acute postoperative pain","volume":"377","author":"Wu","year":"2011","journal-title":"Lancet."},{"key":"ref_19","unstructured":"American Society of Anesthesiologists (ASA) (2020). Standards for Basic Anesthetic Monitoring, ASA."},{"key":"ref_20","unstructured":"European Society of Anaesthesiology and Intensive Care (ESAIC) (2021). Perioperative Monitoring Guidelines, ESAIC."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1097\/ALN.0000000000004002","article-title":"2022 ASA Practice Guidelines for Management of the Difficult Airway","volume":"136","author":"Apfelbaum","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/00000542-199909000-00022","article-title":"A simplified risk score for predicting PONV","volume":"91","author":"Apfel","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1213\/ANE.0000000000004833","article-title":"Fourth Consensus Guidelines for the Management of PONV","volume":"131","author":"Gan","year":"2020","journal-title":"Anesth. Analg."},{"key":"ref_24","first-page":"CD012859","article-title":"Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: A network meta-analysis","volume":"10","author":"Weibel","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","first-page":"173","article-title":"Postoperative pain management-2018 consensus statement","volume":"50","author":"Daszkiewicz","year":"2018","journal-title":"Anaesthesiol. Intensive Ther."},{"key":"ref_26","unstructured":"ASA (2018). Practice Guidelines for Moderate Procedural Sedation and Analgesia, ASA."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/0952-8180(94)00001-K","article-title":"The post-anesthesia recovery score revisited","volume":"7","author":"Aldrete","year":"1995","journal-title":"J. Clin. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of pain (VAS)","volume":"304","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Jebb, A.T., Ng, V., and Tay, L. (2021). Advances in Likert scale development (1995\u20132019). Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.637547"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.bjae.2025.03.001","article-title":"Patient-centred outcomes","volume":"25","author":"Brown","year":"2025","journal-title":"BJA Educ."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rubin, D.B. (1987). Multiple Imputation for Nonresponse in Surveys, Wiley.","DOI":"10.1002\/9780470316696"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/S1521-6896(03)00013-2","article-title":"The combined spinal\u2013epidural technique","volume":"17","author":"Rawal","year":"2003","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1111\/j.1365-2044.2005.04113.x","article-title":"Height\/weight adjusted dosing of spinal local anesthetic for Cesarean section","volume":"60","author":"Harten","year":"2005","journal-title":"Anaesthesia"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/ACO.0000000000000712","article-title":"Low-dose spinal anesthesia to prevent spinal-induced hypotension","volume":"32","year":"2019","journal-title":"Curr. Opin. Anaesthesiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/154\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T08:59:51Z","timestamp":1768294791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/1\/154"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["medicina62010154"],"URL":"https:\/\/doi.org\/10.3390\/medicina62010154","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]}}}