Comparative Clinical Outcomes of V-NOTES and Total Laparoscopic Hysterectomy: A One-Year Retrospective Cohort Study at a Tertiary Center

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Aim: The aim of this study was to compare the perioperative and postoperative clinical outcomes of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) and total laparoscopic hysterectomy (TLH) in patients undergoing surgery for benign gynecological indications.Materials and Methods: This retrospective cohort study included patients who underwent hysterectomy at a tertiary referral center between October 1, 2024, and October 1, 2025. Patients with histopathologically confirmed malignancy, emergency procedures, and incomplete data were excluded. A total of 711 patients were analyzed, including 38 in the V-NOTES group and 673 in the TLH group. Demographic, perioperative, and postoperative data were collected and compared between groups.Results: There were no significant differences between the groups in baseline characteristics. Operative time was significantly longer in the V-NOTES group (101.47±17.89 vs. 82.46±12.86 minutes, p0.05). Postoperative pain scores were significantly lower in the V-NOTES group at both the 6th and 24th hours (p=0.003 and p=0.012, respectively). Intraoperative complication rates were similar (p=0.150). Postoperative complications requiring hospitalization were more frequent in the V-NOTES group (7.9% vs. 2.1%), but the difference was not statistically significant (p=0.057).Conclusion: V-NOTES is a safe and feasible alternative to TLH, offering the advantage of reduced postoperative pain with comparable perioperative outcomes. Although operative time was longer, this may be related to the learning curve. Further prospective studies are needed to confirm these findings.

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