Ali Deniz ERKMEN, Kevser ARKAN, Gül ÇAVUŞOĞLU ÇOLAK, Mesut Ali HALİSÇELİK, Özgür ADIGÜZEL, Kübra ÇAKAR YILMAZ, Pınar BİROL İLTER, Süleyman Cemil OGLAK
Southern Clinics of Istanbul Eurasia - 2026;37(3):216-223
Objective: To evaluate the learning curve of vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy during early adoption and to assess changes in operative performance and perioperative safety over consecutive cases. Study Design is retrospective observational learning curve analysis. Setting is tertiary referral center for minimally invasive gynecologic surgery. Forty consecutive patients who underwent vNOTES hysterectomy for benign gynecologic indications. vNOTES hysterectomy performed by a single surgeon during the initial implementation period. Methods: Operative performance was assessed using total operative time, and learning dynamics were evaluated with cumulative summation (CUSUM) analysis. Results: Mean operative time decreased progressively across sequential quartiles, from 89.3+/-7.5 minutes in the first 10 cases to 46.2+/-3.1 minutes in the final 10 cases. CUSUM analysis demonstrated a clear inflection point at approximately the 18th case, indicating transition from early technical adaptation to stabilized operative performance. Minor perioperative complications and conversions occurred only during the early learning phase, with no major complications observed throughout the series. Conclusions: vNOTES hysterectomy suggests a consistent learning curve pattern during early adoption. Operative efficiency improves progressively, with technical proficiency achieved after a limited number of cases and without compromise in perioperative safety. These findings support structured implementation and objective learning curve assessment during the introduction of vNOTES into minimally invasive gynecologic practice.
