Candost HANEDAN, Hande Nur ÖNCÜ, Neslihan ÖZTÜRK, Oğuz Kaan KÖKSAL, Vakkas KORKMAZ
Pelviperineology - 2025;44(3):97-102
Objective: To evaluate the impact of body mass index (BMI) on surgical outcomes in patients undergoing vaginal-natural orifice transluminal endoscopic surgery (v-NOTES) hysterectomy. Materials and Methods: This single-center retrospective cohort study included 104 women who underwent v-NOTES hysterectomy for gynecologic indications between May 2023 and March 2025. Patients were divided into two groups according to BMI: Group 1 (<30 kg/m², n=62) and Group 2 (>=30 kg/m², n=42). Demographic characteristics, operative time, uterine weight, conversion rates, hemoglobin change, hospital stay, and intra- and postoperative complications were compared. All procedures were performed by two surgeons experienced in both endoscopic and vaginal surgery, following a standardized ten-step v-NOTES technique. Results: The median age was 54 years and the median BMI was 28 kg/m². Uterine weight was significantly higher in the obese group compared to the non-obese group (255 g vs. 172 g; p=0.020). However, there were no significant differences in operative time (44 vs. 47 minutes; p=0.169), conversion rates (1.6% vs. 4.8%; p=0.346), complication rates (3.2% vs. 4.8%; p=0.462), or hospital stay (48 hours in both groups; p=0.904). All complications were minor and successfully managed conservatively without reoperation. Conclusion: Despite higher uterine weights in obese patients, surgical outcomes of v-NOTES hysterectomy were comparable between obese and non-obese women. These findings highlight the safety and feasibility of v-NOTES as a minimally invasive option across different BMI groups, supporting its broader application in gynecologic surgery.
